Provider Demographics
NPI:1700852605
Name:INGRAHAM, SHERRY N (MD)
Entity type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:N
Last Name:INGRAHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:SHERRY
Other - Middle Name:L
Other - Last Name:NOVICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:2051 GREENHOUSE RD STE 270
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-7573
Practice Address - Country:US
Practice Address - Phone:281-665-4444
Practice Address - Fax:281-392-6766
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0843207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00326086OtherRR MEDICARE
3835581OtherAETNA HMO
7678699OtherAETNA PPO
8F0820OtherMEDICARE - BRAZORIA
8J9634OtherBCBS
P00326086OtherRR MEDICARE
8F0820OtherMEDICARE - BRAZORIA
TX8F4132Medicare PIN
TX8D7544Medicare PIN