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General NPI Number Information
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NPI Number | 1063985356
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Entity Type | Individual
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Provider Name | DONALD IRBY
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Gender | Male
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Dates
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Enumeration Date | 01/09/2019
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Last Update Date | 01/09/2019
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Provider Practice Location Address
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Address Line | 445 CHAPEL ST
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City | HAMPTON
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State | VA
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Zip | 23669-3912
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Country | US
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Telephone | 757-287-2695
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Fax |
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Provider Business Mailing Address
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Address Line | 445 CHAPEL ST
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City | HAMPTON
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State | VA
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Zip | 23669-3912
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Country | US
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Telephone | 757-287-2695
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Fax |
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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 | 171W00000X
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Taxonomy Name | Contractor
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License Number | 59104B
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License Number State | NJ
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