Provider Demographics
NPI:1720547524
Name:IVANOVA, MAGDALENA (MD)
Entity Type:Individual
Prefix:
First Name:MAGDALENA
Middle Name:
Last Name:IVANOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 SEARLE RD
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02132-3014
Mailing Address - Country:US
Mailing Address - Phone:224-388-9016
Mailing Address - Fax:
Practice Address - Street 1:637 WASHINGTON ST STE 202
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-4579
Practice Address - Country:US
Practice Address - Phone:617-232-2811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-19
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA291387208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics