Provider Demographics
NPI:1801840889
Name:INGLIS, ALAN (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:INGLIS
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:PO BOX 610
Mailing Address - Street 2:
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230-0610
Mailing Address - Country:US
Mailing Address - Phone:413-298-1001
Mailing Address - Fax:413-298-1005
Practice Address - Street 1:168 MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:GREAT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230-1618
Practice Address - Country:US
Practice Address - Phone:413-637-8921
Practice Address - Fax:413-637-3137
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216055207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0184781Medicaid
H70919Medicare UPIN
MA0184781Medicaid