Provider Demographics
NPI:1669661534
Name:SETH L IVINS MD LLC
Entity Type:Organization
Organization Name:SETH L IVINS MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:IVINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-999-8830
Mailing Address - Street 1:2601 ANNAND DR
Mailing Address - Street 2:SUITE 19
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-3719
Mailing Address - Country:US
Mailing Address - Phone:302-999-8830
Mailing Address - Fax:302-999-8831
Practice Address - Street 1:2601 ANNAND DR
Practice Address - Street 2:SUITE 19
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-3719
Practice Address - Country:US
Practice Address - Phone:302-999-8830
Practice Address - Fax:302-999-8831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty