Basic Information
| Provider Information | |||||||||
| NPI: | 1477792604 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | IRBY | ||||||||
| FirstName: | IRENE | ||||||||
| MiddleName: | GEK-HIA | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 64131 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212644131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105717800 | ||||||||
| FaxNumber: | 4104710362 | ||||||||
| Practice Location | |||||||||
| Address1: | 108 FORBES ST | ||||||||
| Address2: | SECOND FLOOR | ||||||||
| City: | ANNAPOLIS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 214011502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105717880 | ||||||||
| FaxNumber: | 4105710362 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/11/2009 | ||||||||
| LastUpdateDate: | 10/21/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LC0200X | R202633 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Critical Care Medicine | 363LC0200X | R762005 | MS | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 544102100 | 05 | MD | MEDICAID |