Provider Demographics
NPI:1760572747
Name:INGARRA, THOMAS SALVADORE (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:SALVADORE
Last Name:INGARRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 HURLEY AVE
Mailing Address - Street 2:SUITE 12
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-3739
Mailing Address - Country:US
Mailing Address - Phone:845-331-2009
Mailing Address - Fax:845-331-2012
Practice Address - Street 1:40 HURLEY AVE
Practice Address - Street 2:SUITE 12
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-3739
Practice Address - Country:US
Practice Address - Phone:845-331-2009
Practice Address - Fax:845-331-2012
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY137125-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY54A801Medicare ID - Type Unspecified
NYB16242Medicare UPIN