MEDICARE: DR. JOHN F IRVING M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	028175	CT
2	207XS0114X	Adult Reconstructive Orthopaedic Surgery Physician	28175	CT
3	207X00000X	Orthopaedic Surgery Physician	28175	CT

General Provider Information

NPI Number	:	1124024674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN F IRVING M.D.

Provider Business Mailing Address
First Line	:	2408 WHITNEY AVE
Second Line	:
City	:	HAMDEN
State	:	CT
Zip	:	06518-3209
Country	:	US
Telephone Number	:	203-626-0160
Fax Number	:	203-294-6734

Provider Business Practice Location Address
First Line	:	9 WASHINGTON AVE FL 1-A
Second Line	:
City	:	HAMDEN
State	:	CT
Zip	:	06518-3267
Country	:	US
Telephone Number	:	203-865-6784
Fax Number	:	203-865-6788

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	03/07/2022

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