1306215371 NPI number — DR. LYNN IRWIN PSYA. D.

Table of content: KYLIE TREBOUR (NPI 1366276917)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306215371 NPI number — DR. LYNN IRWIN PSYA. D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
IRWIN
Provider First Name:
LYNN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSYA. D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306215371
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/28/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 66
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRADFORD
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05033
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-222-9235
Provider Business Mailing Address Fax Number:
802-222-5864

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
331 UPPER PLAIN (U.S ROUTE 5)
Provider Second Line Business Practice Location Address:
BRADFORD MEDICAL CENTER
Provider Business Practice Location Address City Name:
BRADFORD
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-222-5155
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/21/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 102L00000X , with the licence number:  098.0133629 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)