Maillard, Ivan Patrick

Maillard, Ivan Patrick is an individual health care provider with primary practice located at 3400 Spruce St , Philadelphia PA 19104-4238. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Hematology. Allopathic & Osteopathic Physicians / Hematology is his primary health care specialty. Maillard, Ivan Patrick can be contacted via phone (215) 615-0063.

Contact Information

Primary practice address
3400 Spruce St Philadelphia PA 19104-4238
Phone: (215) 615-0063
Fax: (215) 349-8144
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X MD423465 Pennsylvania
Allopathic & Osteopathic Physicians / Hematology 207RH0000X MD423465 Pennsylvania

Profile Details

NPI number 1568403269
LBN Legal business name Maillard, Ivan Patrick
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 10th, 2006
Last updated Sep 19th, 2019 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1568403269 NPPES
Pennsylvania MEDICAID 1013530260002

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