Provider Demographics
NPI:1629074745
Name:GARCIA, IVAN HORACIO JR (MD)
Entity Type:Individual
Prefix:DR
First Name:IVAN
Middle Name:HORACIO
Last Name:GARCIA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2925 LORD BALTIMORE DR.
Mailing Address - Street 2:STE 300
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21244-2568
Mailing Address - Country:US
Mailing Address - Phone:410-277-3937
Mailing Address - Fax:410-281-9388
Practice Address - Street 1:2925 LORD BALTIMORE DR.
Practice Address - Street 2:STE 300
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21244-2568
Practice Address - Country:US
Practice Address - Phone:410-277-3937
Practice Address - Fax:410-281-9388
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0032680174400000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD390291900Medicaid
MDE10427Medicare UPIN
MD390291900Medicaid