Provider Demographics
NPI:1881667905
Name:RAPPAPORT, IVAN PAUL (MD)
Entity type:Individual
Prefix:
First Name:IVAN
Middle Name:PAUL
Last Name:RAPPAPORT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:I
Other - Middle Name:PAUL
Other - Last Name:RAPPAPORT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:414 MAPLE AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-5550
Mailing Address - Country:US
Mailing Address - Phone:518-587-9243
Mailing Address - Fax:518-587-6836
Practice Address - Street 1:414 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-5550
Practice Address - Country:US
Practice Address - Phone:518-587-9243
Practice Address - Fax:518-587-6836
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-09
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY160824174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY08U281OtherEMPIRE HEALTHCHOICE
NY07112OtherMVP HEALTH PLAN
NY10001682OtherCDPHP
NY000471896001OtherBLUE SHIELD NORTHEASTERN
NY10001682OtherCDPHP
NY07112OtherMVP HEALTH PLAN