Provider Demographics
NPI:1700496759
Name:JOSEPH, IVANNA JENIFERR (MD)
Entity Type:Individual
Prefix:
First Name:IVANNA
Middle Name:JENIFERR
Last Name:JOSEPH
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 1:733 ARBORETUM WAY
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-3833
Mailing Address - Country:US
Mailing Address - Phone:646-318-2431
Mailing Address - Fax:
Practice Address - Street 1:733 ARBORETUM WAY
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-3833
Practice Address - Country:US
Practice Address - Phone:646-318-2431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program