Provider Demographics
NPI:1245203652
Name:PROSSER, INGRID ANNE MARIE (MD)
Entity Type:Individual
Prefix:
First Name:INGRID
Middle Name:ANNE MARIE
Last Name:PROSSER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10710 MIDLOTHIAN TPKE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-4722
Mailing Address - Country:US
Mailing Address - Phone:804-897-2100
Mailing Address - Fax:804-897-9074
Practice Address - Street 1:10710 MIDLOTHIAN TPKE
Practice Address - Street 2:SUITE 200
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-4722
Practice Address - Country:US
Practice Address - Phone:804-897-2100
Practice Address - Fax:804-897-9074
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101046465207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6244327Medicaid
160000707Medicare ID - Type Unspecified
E82834Medicare UPIN