Provider Demographics
NPI:1780629097
Name:GHEEN, INGRID (MD)
Entity Type:Individual
Prefix:
First Name:INGRID
Middle Name:
Last Name:GHEEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11600 MAGRUDER LN
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4366
Mailing Address - Country:US
Mailing Address - Phone:301-652-6612
Mailing Address - Fax:301-816-9174
Practice Address - Street 1:11600 MAGRUDER LN
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-4366
Practice Address - Country:US
Practice Address - Phone:301-652-6612
Practice Address - Fax:301-816-9174
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0023432208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
230070OtherMAMSI
03523125OtherBCBS-ANTHEM
4106OtherBCBC-NCA
230070OtherMAMSI
B94139Medicare UPIN