Provider Demographics
NPI:1851358444
Name:INGRAM, BETH E (MD)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:E
Last Name:INGRAM
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:1100 REID PKWY
Mailing Address - Street 2:MEDICAL STAFF SERVS
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1157
Mailing Address - Country:US
Mailing Address - Phone:765-983-3293
Mailing Address - Fax:765-983-3219
Practice Address - Street 1:1100 REID PKWY
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1157
Practice Address - Country:US
Practice Address - Phone:765-983-3164
Practice Address - Fax:765-983-3260
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN010409152085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100465370Medicaid
INF85994Medicare UPIN