Provider Demographics
NPI:1275646515
Name:CHACON, INGRID M (MD)
Entity Type:Individual
Prefix:
First Name:INGRID
Middle Name:M
Last Name:CHACON
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 1:367 S GULPH RD
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-3121
Mailing Address - Country:US
Mailing Address - Phone:956-616-5427
Mailing Address - Fax:956-928-9247
Practice Address - Street 1:1801 S 5TH ST STE 214
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-2932
Practice Address - Country:US
Practice Address - Phone:956-616-5427
Practice Address - Fax:956-928-9247
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2583207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1P3295OtherPTAN
TX178442303Medicaid
TX178442304Medicaid
TX178442302Medicaid
TX178442305Medicaid
TXP00278591OtherMEDICARE RAILROAD
TX178442302Medicaid
TXI48332Medicare UPIN
TX295374YNG9Medicare PIN