Individual
DR. IVY LYNN BRACKUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1353 DORCHESTER AVE, DORCHESTER, MA 02122-2932
(617) 288-3230
Mailing address
1353 DORCHESTER AVE, DORCHESTER, MA 02122-2932
(617) 288-3230
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
15530
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3177190
—
MA
Enumeration date
03/01/2006
Last updated
09/11/2024
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