Healthcare Provider Details

I. General information

NPI: 1982658563
Provider Name (Legal Business Name): DENNIS W IVILL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 08/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 LANSDOWNE AVE STE 303
DARBY PA
19023-1333
US

IV. Provider business mailing address

804 SOUTH AVE APT D8
SECANE PA
19018-4426
US

V. Phone/Fax

Practice location:
  • Phone: 215-334-3869
  • Fax: 215-755-3300
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD042916L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number25MA07886000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: