Individual
RICHARD LEWIS IRVING III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MHS, PA-C
Contact information
Practice address
3401 N BROAD ST, PHILADELPHIA, PA 19140-5103
(215) 707-3133
(215) 707-3945
Mailing address
2450 W HUNTING PARK AVE, 3/208N, PHILADELPHIA, PA 19129-1302
(215) 707-8561
(215) 707-3677
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
MA052325
PA
363AS0400X
Surgical Physician Assistant
Primary
0010-00728
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0476PA
—
SC
Enumeration date
06/11/2006
Last updated
05/21/2014
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