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Individual
MARY E IVY
Active
Individual
MARY E IVY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD040279L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0011155040001
—
PA
01
—
01882901
CAPITAL BLUE CROSS
PA
01
—
512264
HIGHMARK BLUE SHIELD
PA
01
—
5171073
AETNA NON-HMO
PA
01
—
52447 S1QG
GEISINGER HEALTH PLAN
PA
01
—
578399
AETNA HMO
PA
01
—
D71478
HEALTH ASSURANCE
PA
01
—
P002302
GATEWAY HEALTH PLAN
PA
Enumeration date
12/02/2005
Last updated
09/01/2007
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