Individual
IVAN PATRICK MAILLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3400 SPRUCE ST, PHILADELPHIA, PA 19104-4238
(215) 615-0063
(215) 349-8144
Mailing address
3400 SPRUCE ST, PHILADELPHIA, PA 19104-4238
(215) 615-0063
(215) 349-8144
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD423465
PA
207RH0000X
Hematology (Internal Medicine) Physician
Primary
MD423465
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013530260002
—
PA
Enumeration date
06/10/2006
Last updated
09/19/2019
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