=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477650679
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IVY SAVOY-WHITFIELD MD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2006
-----------------------------------------------------
Last Update Date | 07/14/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1417 N BATTLEFIELD BLVD SUITE 360
-----------------------------------------------------
City | CHESAPEAKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23320-4516
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-410-3562
-----------------------------------------------------
Fax | 757-410-3563
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1331
-----------------------------------------------------
City | CHESAPEAKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23327-1331
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-410-3562
-----------------------------------------------------
Fax | 757-410-3563
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | IVY V SAVOY-WHITFIELD
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 757-410-3562
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 0101039911
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------