Provider Demographics
NPI:1164488490
Name:INGERMAN, MARK J (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:INGERMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:100 E LANCASTER AVE
Mailing Address - Street 2:MOB EAST 556
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3450
Mailing Address - Country:US
Mailing Address - Phone:610-896-0210
Mailing Address - Fax:610-896-5101
Practice Address - Street 1:100 E LANCASTER AVE
Practice Address - Street 2:MOB EAST 556
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3450
Practice Address - Country:US
Practice Address - Phone:610-896-0210
Practice Address - Fax:610-896-5101
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2020-01-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD027650E207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA091243OtherBLUE SHIELD
PA1060291Medicaid
PAB35486Medicare UPIN
PA091243Medicare ID - Type Unspecified