Provider Demographics
NPI:1700852605
Name:INGRAHAM, SHERRY N (MD)
Entity Type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:N
Last Name:INGRAHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:SHERRY
Other - Middle Name:L
Other - Last Name:NOVICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2950 CULLEN BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-3922
Mailing Address - Country:US
Mailing Address - Phone:281-412-6262
Mailing Address - Fax:281-412-6740
Practice Address - Street 1:430 S MASON RD
Practice Address - Street 2:SUITE 101
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-2447
Practice Address - Country:US
Practice Address - Phone:281-392-3803
Practice Address - Fax:281-392-6766
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0843207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00326086OtherRR MEDICARE
3835581OtherAETNA HMO
7678699OtherAETNA PPO
8F0820OtherMEDICARE - BRAZORIA
8J9634OtherBCBS
P00326086OtherRR MEDICARE
8F0820OtherMEDICARE - BRAZORIA
TX8F4132Medicare PIN
TX8D7544Medicare PIN