Provider Demographics
NPI:1457399453
Name:IVES, DAVID V (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:V
Last Name:IVES
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 1:482 BEDFORD ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-1402
Mailing Address - Country:US
Mailing Address - Phone:781-528-2440
Mailing Address - Fax:
Practice Address - Street 1:482 BEDFORD ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-1402
Practice Address - Country:US
Practice Address - Phone:781-528-2440
Practice Address - Fax:781-528-2450
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA72667207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3111865Medicaid
MA3111865Medicaid
MAF28980Medicare UPIN