MEDICARE: MR. BRIAN R IRWIN D.O.

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	207Q00000X	Family Medicine Physician	12236	NH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427070630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRIAN R IRWIN D.O.

Provider Business Mailing Address
First Line	:	PO BOX 234
Second Line	:	TAMWORTH FAMILY MEDICINE
City	:	WEST OSSIPEE
State	:	NH
Zip	:	03890-0234
Country	:	US
Telephone Number	:	603-323-3311
Fax Number	:	603-323-9305

Provider Business Practice Location Address
First Line	:	577 WHITE MOUNTAIN HIGHWAY
Second Line	:
City	:	TAMWORTH
State	:	NH
Zip	:	03886-4631
Country	:	US
Telephone Number	:	603-323-3311
Fax Number	:	603-323-9305

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

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	03/06/2025

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