Provider Demographics
NPI:1275865867
Name:INGALLS, VIRGINIA M
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:M
Last Name:INGALLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10181 JASMAC LN
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-3033
Mailing Address - Country:US
Mailing Address - Phone:804-730-6547
Mailing Address - Fax:
Practice Address - Street 1:10181 JASMAC LN
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-3033
Practice Address - Country:US
Practice Address - Phone:804-730-6547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019001626171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications