Individual
GENNADIY IVANOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
520 BUSTLETON PIKE, FEASTERVILLE TREVOSE, PA 19053
(215) 631-3873
(215) 631-3899
Mailing address
520 BUSTLETON PIKE, FEASTERVILLE TREVOSE, PA 19053-6052
(215) 631-3873
(215) 631-3899
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
MD454021
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
464979
MEDICARE NUMBER
PA
Enumeration date
12/03/2009
Last updated
05/25/2021
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