Provider Demographics
NPI:1740060730
Name:IVYMOUNT CLINIC LLC
Entity type:Organization
Organization Name:IVYMOUNT CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRNP
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOCHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-746-2126
Mailing Address - Street 1:6309 IVYMOUNT RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-3326
Mailing Address - Country:US
Mailing Address - Phone:410-746-2126
Mailing Address - Fax:
Practice Address - Street 1:6309 IVYMOUNT RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-3326
Practice Address - Country:US
Practice Address - Phone:410-746-2126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty