Provider Demographics
NPI:1710040621
Name:INGRAM, MARK
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:INGRAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 E 149TH ST
Mailing Address - Street 2:LINCOLN HOSPITAL, DEPT. OF SURGERY, RM. 6-20
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-5504
Mailing Address - Country:US
Mailing Address - Phone:718-579-5900
Mailing Address - Fax:718-579-4620
Practice Address - Street 1:234 E 149TH ST
Practice Address - Street 2:LINCOLN HOSPITAL, DEPT. OF SURGERY, RM. 6-20
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5504
Practice Address - Country:US
Practice Address - Phone:718-579-5900
Practice Address - Fax:718-579-4620
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205770207RG0100X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgery