Provider Demographics
NPI:1578004172
Name:INGRAM, GAIL R
Entity Type:Individual
Prefix:MS
First Name:GAIL
Middle Name:R
Last Name:INGRAM
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 1:3010 CHAPEL VIEW DR
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-3430
Mailing Address - Country:US
Mailing Address - Phone:240-360-7143
Mailing Address - Fax:
Practice Address - Street 1:3010 CHAPEL VIEW DR
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-3430
Practice Address - Country:US
Practice Address - Phone:240-360-7143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-15
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant