Provider Demographics
NPI:1235172966
Name:IVINS, SETH LONDON (MD)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:LONDON
Last Name:IVINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SUMMIT LN
Mailing Address - Street 2:
Mailing Address - City:MONTCHANIN
Mailing Address - State:DE
Mailing Address - Zip Code:19710
Mailing Address - Country:US
Mailing Address - Phone:302-658-4778
Mailing Address - Fax:
Practice Address - Street 1:620 STANTON CHRISTIANA RD
Practice Address - Street 2:SUITE 305
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2133
Practice Address - Country:US
Practice Address - Phone:302-999-8830
Practice Address - Fax:302-633-1375
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10002892207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000183701Medicaid
DE013706B68Medicare ID - Type Unspecified
DE0000183701Medicaid