Provider Demographics
NPI:1902018252
Name:CORREA, IVAN E (MD)
Entity Type:Individual
Prefix:DR
First Name:IVAN
Middle Name:E
Last Name:CORREA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 INFIRMARY WAY
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01003-9288
Mailing Address - Country:US
Mailing Address - Phone:413-577-5000
Mailing Address - Fax:413-577-3131
Practice Address - Street 1:150 INFIRMARY WAY
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01003-9288
Practice Address - Country:US
Practice Address - Phone:413-577-5000
Practice Address - Fax:413-577-3131
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96375207QG0300X
MA1016266207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine