MEDICARE: LINDA C IRVINE MD

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	207R00000X	Internal Medicine Physician	35.054544	OH

General Provider Information

NPI Number	:	1306920350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA C IRVINE MD

Provider Business Mailing Address
First Line	:	2107 4TH ST
Second Line	:
City	:	CUYAHOGA FALLS
State	:	OH
Zip	:	44221-3211
Country	:	US
Telephone Number	:	330-928-2818
Fax Number	:	330-928-1755

Provider Business Practice Location Address
First Line	:	2107 4TH ST
Second Line	:
City	:	CUYAHOGA FALLS
State	:	OH
Zip	:	44221-3211
Country	:	US
Telephone Number	:	330-928-2818
Fax Number	:	330-928-1755

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

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	07/08/2007

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