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General NPI Number Information
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NPI Number | 1609975952
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Entity Type | Individual
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Provider Name | LISA ANN IRVINE M.D. PH.D. F.A.A.P.
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Gender | Female
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 01/31/2026
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Provider Practice Location Address
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Address Line | 10230 NEW HAMPSHIRE AVE STE 205
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City | SILVER SPRING
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State | MD
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Zip | 20903-1423
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Country | US
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Telephone | 301-434-1096
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Fax |
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Provider Business Mailing Address
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Address Line | 19152 COTON RESERVE DR
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City | LEESBURG
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State | VA
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Zip | 20176-1662
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Country | US
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Telephone | 703-314-0702
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Fax | 703-829-1194
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 0101233858
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | D0091856
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License Number State | MD
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