Healthcare Provider Details

I. General information

NPI: 1508950122
Provider Name (Legal Business Name): ELIUD IRIZARRY CLAUDIO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ELIUD IRIZARRY M.D.

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 02/08/2021
Certification Date: 02/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 RIVERSIDE CIR
ROANOKE VA
24016-4955
US

IV. Provider business mailing address

213 S JEFFERSON ST STE 625
ROANOKE VA
24011-1713
US

V. Phone/Fax

Practice location:
  • Phone: 540-224-5170
  • Fax: 540-985-9427
Mailing address:
  • Phone: 540-224-5516
  • Fax: 540-224-5684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License Number016446
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number016446
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number0101271055
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: