Healthcare Provider Details

I. General information

NPI: 1609975952
Provider Name (Legal Business Name): LISA ANN IRVINE M.D. PH.D. F.A.A.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 SEMINOLE LN STE 110
CHARLOTTESVILLE VA
22901-8395
US

IV. Provider business mailing address

2325 SEMINOLE LN STE 110
CHARLOTTESVILLE VA
22901-8395
US

V. Phone/Fax

Practice location:
  • Phone: 434-340-0879
  • Fax:
Mailing address:
  • Phone: 703-314-0702
  • Fax: 703-829-1194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101233858
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0091856
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: