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General NPI Number Information
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NPI Number | 1023544210
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Entity Type | Individual
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Provider Name | LUCAS WADE IRWIN D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/07/2017
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 1061 N FRONT ST STE 2
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City | PHILIPSBURG
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State | PA
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Zip | 16866-8257
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Country | US
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Telephone | 814-376-6200
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Fax | 814-376-6215
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Provider Business Mailing Address
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Address Line | 1800 E PARK AVE
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City | STATE COLLEGE
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State | PA
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Zip | 16803-6701
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Country | US
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Telephone | 814-231-7100
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Fax | 814-238-0790
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS019619
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OT017622
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License Number State | PA
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