Individual
IVY AKID
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
600 N WOLFE ST, BALTIMORE, MD 21287-0005
(410) 955-9441
Mailing address
6201 GREENLEIGH AVE FL 2, MIDDLE RIVER, MD 21220-2004
(850) 431-6403
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
TRN 21218
FL
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
Primary
D89995
MD
Other
Enumeration date
05/26/2015
Last updated
01/05/2024
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