Provider Demographics
NPI:1528092491
Name:IRWIN, JOHN HAWKINS III (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:HAWKINS
Last Name:IRWIN
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 AIRPORT RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-4524
Mailing Address - Country:US
Mailing Address - Phone:207-680-2070
Mailing Address - Fax:207-680-2074
Practice Address - Street 1:40 AIRPORT RD
Practice Address - Street 2:SUITE 2
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-4524
Practice Address - Country:US
Practice Address - Phone:207-680-2070
Practice Address - Fax:207-680-2074
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1238207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME197070099Medicaid
MEMM092001Medicare PIN
IR MM0920Medicare ID - Type Unspecified
ME197070099Medicaid