Provider Demographics
NPI:1689683740
Name:INGRAM, MARY KATHLEEN (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KATHLEEN
Last Name:INGRAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 ST VINCENTS DRIVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205
Mailing Address - Country:US
Mailing Address - Phone:205-930-1800
Mailing Address - Fax:205-930-1819
Practice Address - Street 1:806 ST VINCENTS DRIVE
Practice Address - Street 2:SUITE 500
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205
Practice Address - Country:US
Practice Address - Phone:205-930-1800
Practice Address - Fax:205-930-1819
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL25165207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51514746Medicare PIN
H10094Medicare UPIN