Provider Demographics
NPI:1083630057
Name:INGRAM, CHRISTOPHER MACDONALD (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:MACDONALD
Last Name:INGRAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 W 137TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10030-2409
Mailing Address - Country:US
Mailing Address - Phone:917-903-3416
Mailing Address - Fax:
Practice Address - Street 1:111 BROADWAY FL 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10006-1995
Practice Address - Country:US
Practice Address - Phone:646-461-2544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2021-04-12
Deactivation Date:2006-07-19
Deactivation Code:
Reactivation Date:2006-09-07
Provider Licenses
StateLicense IDTaxonomies
NY202047207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01818744Medicaid
NY03B311Medicare Oscar/Certification
NY01818744Medicaid