Provider Demographics
NPI:1427188663
Name:BELLWOOD, INGRID AGATHA (MD)
Entity Type:Individual
Prefix:DR
First Name:INGRID
Middle Name:AGATHA
Last Name:BELLWOOD
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 1:1300 BOULEVARD WAY
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94595-1208
Mailing Address - Country:US
Mailing Address - Phone:925-938-4823
Mailing Address - Fax:
Practice Address - Street 1:1300 BOULEVARD WAY
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94595-1208
Practice Address - Country:US
Practice Address - Phone:925-938-4823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG31959207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA44929Medicare UPIN