Provider Demographics
NPI:1851560262
Name:LOUIS IVEY MD AND ASSOCIATES P A
Entity Type:Organization
Organization Name:LOUIS IVEY MD AND ASSOCIATES P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:IVEY
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:301-913-9207
Mailing Address - Street 1:7316 WISCONSIN AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-2989
Mailing Address - Country:US
Mailing Address - Phone:301-913-9207
Mailing Address - Fax:301-913-5720
Practice Address - Street 1:7316 WISCONSIN AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-2989
Practice Address - Country:US
Practice Address - Phone:301-913-9207
Practice Address - Fax:301-913-5720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-29
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD5404208600000X
MDD0009282208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC4401100Medicaid
G02197Medicare PIN
G02197 L01Medicare UPIN
0845160001Medicare NSC