Provider Demographics
NPI:1518386242
Name:INGRAHAM, BENJAMIN (DO)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:INGRAHAM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3425 S CLARKSON ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-2811
Mailing Address - Country:US
Mailing Address - Phone:303-780-8220
Mailing Address - Fax:303-789-8470
Practice Address - Street 1:3425 S CLARKSON ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2811
Practice Address - Country:US
Practice Address - Phone:303-789-8220
Practice Address - Fax:303-789-8470
Is Sole Proprietor?:No
Enumeration Date:2014-04-09
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11275969-1204208100000X
IL125-0645132081P0301X
390200000X
CO67909208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P0301XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationBrain Injury Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program