Provider Demographics
NPI:1629068127
Name:WATKINS, INGRID K (MD)
Entity Type:Individual
Prefix:
First Name:INGRID
Middle Name:K
Last Name:WATKINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 278980
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-426-4084
Mailing Address - Fax:585-426-4631
Practice Address - Street 1:10 SOUTH POINTE LANDING
Practice Address - Street 2:SUITE 250
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14606-3481
Practice Address - Country:US
Practice Address - Phone:585-426-4084
Practice Address - Fax:585-426-4631
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI41521207Q00000X
NY239601207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H05049Medicare UPIN
NYRB1083Medicare PIN