Individual
RHEA IVINS
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2212 GENESEE ST, UTICA, NY 13502-5809
(315) 734-3161
(315) 734-3411
Mailing address
2212 GENESEE ST, UTICA, NY 13502-5809
(315) 734-3161
(315) 734-3411
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
172299-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01104223
—
NY
Enumeration date
10/24/2005
Last updated
07/09/2007
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