Provider Demographics
NPI:1922589480
Name:LOCKWARD, IVAN RAFAEL JR (MD, MPH)
Entity Type:Individual
Prefix:MR
First Name:IVAN
Middle Name:RAFAEL
Last Name:LOCKWARD
Suffix:JR
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1412-22 FAIRMOUNT AVENUE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-2900
Mailing Address - Country:US
Mailing Address - Phone:215-684-5344
Mailing Address - Fax:215-232-4093
Practice Address - Street 1:401-55 W ALLEGHENY AVENUE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19133
Practice Address - Country:US
Practice Address - Phone:215-291-2500
Practice Address - Fax:215-291-2587
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-23
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR33783R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine