MEDICARE: DR. CHARLES IVES M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	0101030875	VA
2	174400000X	Specialist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	212951	OTHER	VA	CIGNA
3	393391	OTHER	VA	ANTHEM
4	17864	OTHER	VA	OPTIMA
5	1700234	OTHER	VA	UNITED HEALTHCARE
6	514250	OTHER	VA	MAMSI

General Provider Information

NPI Number	:	1417955006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES IVES M.D.

Provider Business Mailing Address
First Line	:	160 KINGSLEY LN
Second Line	:	SUITE 400
City	:	NORFOLK
State	:	VA
Zip	:	23505-4600
Country	:	US
Telephone Number	:	757-889-6500
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 KINGSLEY LN
Second Line	:	SUITE 400
City	:	NORFOLK
State	:	VA
Zip	:	23505-4600
Country	:	US
Telephone Number	:	757-889-6500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	08/11/2008

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Directions to “ DR. CHARLES IVES M.D.” Practice Location

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