Provider Demographics
NPI:1790894293
Name:INGHAM, DENISE A (MD)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:A
Last Name:INGHAM
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 1:17625 EL CAMINO REAL STE 250
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3085
Mailing Address - Country:US
Mailing Address - Phone:281-990-0800
Mailing Address - Fax:281-990-0829
Practice Address - Street 1:17625 EL CAMINO REAL STE 250
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3085
Practice Address - Country:US
Practice Address - Phone:281-990-0800
Practice Address - Fax:281-990-0829
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH86932084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE67003Medicare UPIN