| Doctor Name: | GENNADIY IVANOV |
| NPI Number: | 1861720815 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | MD454021 |
| Business Practice Address: | 1155 East Mountain Blvd. Wilkes-barre, PA - 187023377 |
| Business Phone Number: | 5708087916 |
| Business Fax Number: | 5708086006 |
| Mailing Address: | 100 N Academy Ave, DANVILLE |
| State: | PA |
| Postal Code: | 178224903 |
| Phone Number: | 5702716144 |
| Fax Number: | |
| NPI Enumeration Date: | 12/03/2009 |
| NPI Last Update Date: | 12/08/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207V00000X |
| License Number: | MD454021 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Obstetrics & Gynecology |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |