Healthcare Provider Details

I. General information

NPI: 1306079306
Provider Name (Legal Business Name): IVAN A CHEBIB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2009
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MASSACHUSETTS GENERAL HOSPITAL 55 FRUIT ST.
BOSTON MA
02114
US

IV. Provider business mailing address

MASSACHUSETTS GENERAL HOSPITAL 55 FRUIT ST.
BOSTON MA
02114
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-2967
  • Fax:
Mailing address:
  • Phone: 617-726-2967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number253670
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberL-232326
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: