Provider Demographics
NPI:1497710719
Name:ISDITH, INGRID L (DO)
Entity Type:Individual
Prefix:DR
First Name:INGRID
Middle Name:L
Last Name:ISDITH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1395 S STATE ROAD 7
Mailing Address - Street 2:SUITE 450
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-9325
Mailing Address - Country:US
Mailing Address - Phone:561-798-1233
Mailing Address - Fax:561-798-1655
Practice Address - Street 1:8188 S JOG RD
Practice Address - Street 2:SUITE 203
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33472-2952
Practice Address - Country:US
Practice Address - Phone:561-740-1911
Practice Address - Fax:561-740-1856
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2022-02-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLOS7993207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260923100Medicaid
FLH30531Medicare UPIN
FLE5020AMedicare ID - Type Unspecified