Healthcare Provider Details

I. General information

NPI: 1154902203
Provider Name (Legal Business Name): MATEO JAMES KIRWAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2021
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 S SHIRLINGTON RD FL 11
ARLINGTON VA
22206-3601
US

IV. Provider business mailing address

2800 S SHIRLINGTON RD FL 11
ARLINGTON VA
22206-3601
US

V. Phone/Fax

Practice location:
  • Phone: 703-892-6500
  • Fax:
Mailing address:
  • Phone: 703-892-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number0101289124
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: