Provider Demographics
NPI:1740203744
Name:INGALLS, CHARLES EDGAR III (MD, FACS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:EDGAR
Last Name:INGALLS
Suffix:III
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 E. SOUTH BLVD
Mailing Address - Street 2:SUITE 908
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-2014
Mailing Address - Country:US
Mailing Address - Phone:334-284-6500
Mailing Address - Fax:334-284-6202
Practice Address - Street 1:2055 E. SOUTH BLVD
Practice Address - Street 2:SUITE 908
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-2014
Practice Address - Country:US
Practice Address - Phone:334-284-6500
Practice Address - Fax:334-284-6202
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6026174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000089020Medicaid
AL51089020OtherBCBS
ALC70774Medicare UPIN
AL51089020OtherBCBS