Provider Demographics
NPI:1407942212
Name:ACEVEDO, IGNACIO SR (MD)
Entity Type:Individual
Prefix:
First Name:IGNACIO
Middle Name:
Last Name:ACEVEDO
Suffix:SR
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:PO BOX 51962
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PR
Mailing Address - Zip Code:00950-1962
Mailing Address - Country:US
Mailing Address - Phone:787-884-6572
Mailing Address - Fax:787-854-3153
Practice Address - Street 1:URB ATENAS MARGINAL ELLIOT VELEZ B 47
Practice Address - Street 2:
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-884-6572
Practice Address - Fax:787-854-3153
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10514208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF28865Medicare UPIN