Provider Demographics
NPI:1386763076
Name:IVANOVA, ISKRA IVANOVA (MD)
Entity type:Individual
Prefix:DR
First Name:ISKRA
Middle Name:IVANOVA
Last Name:IVANOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 2ND AVE N
Mailing Address - Street 2:APT. 526
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-4995
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:123 2ND AVE N
Practice Address - Street 2:APT. 526
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-4995
Practice Address - Country:US
Practice Address - Phone:206-987-3996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT183412207L00000X
WAMD60057958207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology