Healthcare Provider Details

I. General information

NPI: 1467037614
Provider Name (Legal Business Name): HOPE L IRWIN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2021
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9427 LORTON MARKET ST
LORTON VA
22079-1963
US

IV. Provider business mailing address

PO BOX 791775
BALTIMORE MD
21279-1775
US

V. Phone/Fax

Practice location:
  • Phone: 571-336-7614
  • Fax: 571-336-7615
Mailing address:
  • Phone: 571-302-5000
  • Fax: 571-302-5001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110008076
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: