Provider Demographics
NPI:1417955006
Name:IVES, CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:IVES
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 1:160 KINGSLEY LN
Mailing Address - Street 2:SUITE 400
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-4600
Mailing Address - Country:US
Mailing Address - Phone:757-889-6500
Mailing Address - Fax:
Practice Address - Street 1:160 KINGSLEY LN
Practice Address - Street 2:SUITE 400
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-4600
Practice Address - Country:US
Practice Address - Phone:757-889-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101030875174400000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7311087Medicaid
VA212951OtherCIGNA
VA393391OtherANTHEM
VA17864OtherOPTIMA
VA1700234OtherUNITED HEALTHCARE
VA514250OtherMAMSI
VA1700234OtherUNITED HEALTHCARE
VA17864OtherOPTIMA