Provider Demographics
NPI:1265581383
Name:INGRAM PEDIATRICS, P.A
Entity type:Organization
Organization Name:INGRAM PEDIATRICS, P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:E
Authorized Official - Last Name:INGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-321-1591
Mailing Address - Street 1:4100 SOUTH HOSPITAL DRIVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2838
Mailing Address - Country:US
Mailing Address - Phone:954-321-1591
Mailing Address - Fax:954-321-1592
Practice Address - Street 1:4101 S HOSPITAL DR
Practice Address - Street 2:SUITE 12
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2857
Practice Address - Country:US
Practice Address - Phone:954-321-1591
Practice Address - Fax:954-321-1592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79116261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL261906700Medicaid