Provider Demographics
NPI:1528002102
Name:INGRAM, DAVID LANE (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LANE
Last Name:INGRAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 N LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-2024
Mailing Address - Country:US
Mailing Address - Phone:919-967-9883
Mailing Address - Fax:919-350-8677
Practice Address - Street 1:3024 NEW BERN AVE
Practice Address - Street 2:ANDREWS CENTER, SUITE 307
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1247
Practice Address - Country:US
Practice Address - Phone:919-350-8493
Practice Address - Fax:919-350-8677
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19062174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8945251Medicaid
NC8945251Medicaid