Provider Demographics
NPI:1679221329
Name:MILLS, IVY SMITH
Entity Type:Individual
Prefix:
First Name:IVY
Middle Name:SMITH
Last Name:MILLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:IVY
Other - Middle Name:DELPHINE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:8502 RHEIMS CT
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-6404
Mailing Address - Country:US
Mailing Address - Phone:443-518-6023
Mailing Address - Fax:
Practice Address - Street 1:9001 WOODYARD RD STE C
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-4264
Practice Address - Country:US
Practice Address - Phone:301-868-7333
Practice Address - Fax:301-868-9023
Is Sole Proprietor?:No
Enumeration Date:2022-03-11
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR144184207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine