Provider Demographics
NPI:1114412145
Name:IVIE, ANNE BEESON (MD)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:BEESON
Last Name:IVIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:
Other - Last Name:BEESON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:21 SUSQUEHANNA VALLEY MALL DR STE A
Practice Address - Street 2:
Practice Address - City:SELINSGROVE
Practice Address - State:PA
Practice Address - Zip Code:17870-9148
Practice Address - Country:US
Practice Address - Phone:570-374-7852
Practice Address - Fax:570-374-7932
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-22
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD474731207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1035051270002Medicaid
PA1S4222OtherMEDICARE