Provider Demographics
NPI:1154492874
Name:INGRALDI, PETER ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:ANTHONY
Last Name:INGRALDI
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 1:148 EAST AVE STE 3A
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-5726
Mailing Address - Country:US
Mailing Address - Phone:203-899-0744
Mailing Address - Fax:203-899-0761
Practice Address - Street 1:148 EAST AVE STE 3A
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-5726
Practice Address - Country:US
Practice Address - Phone:203-899-0744
Practice Address - Fax:203-899-0761
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193429208600000X
CT044779208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01655018Medicaid
NY01655018Medicaid
NYF87957Medicare UPIN