Active NPI
Robert G Irvin, MD
- Specialist
- Charleston, SC
National Provider Identifier
1114022118
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 7002
- Practice address
- 615 Wesley Dr Ste 320
Charleston, SC 29407-7274 - Phone
- (843) 571-2939
- Fax
- (843) 571-4686
- NPI assigned
- Sep 14, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 7002 | SC | Primary |
Addresses
Primary practice location
615 Wesley Dr Ste 320
Charleston, SC 29407-7274
Mailing address
615 Wesley Dr Ste 320
Charleston, SC 29407-7274
Phone (843) 571-2939
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GP0453 | Medicaid | SC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7002 | SC | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158192000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1114022118",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "615 WESLEY DR STE 320",
"city": "CHARLESTON",
"state": "SC",
"postal_code": "294077274",
"telephone_number": "843-571-2939",
"fax_number": "843-571-4686"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "615 WESLEY DR STE 320",
"city": "CHARLESTON",
"state": "SC",
"postal_code": "294077274",
"telephone_number": "843-571-2939",
"fax_number": "843-571-4686"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IRVIN",
"first_name": "ROBERT",
"middle_name": "G",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "SC",
"license": "7002",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "GP0453",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Charleston, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.