Provider Demographics
NPI:1588652150
Name:INGELFINGER, JOSEPH A (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:A
Last Name:INGELFINGER
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 1:55 BROOKSDALE RD
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-1857
Mailing Address - Country:US
Mailing Address - Phone:617-787-5757
Mailing Address - Fax:
Practice Address - Street 1:230 BOWDOIN ST
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02122-1817
Practice Address - Country:US
Practice Address - Phone:617-754-0100
Practice Address - Fax:617-754-0230
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA39752207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2045125Medicaid
MAM09294Medicare ID - Type Unspecified
MA2045125Medicaid