Provider Demographics
NPI:1841289337
Name:IGLEHART, IREDELL WADDELL III (MD)
Entity type:Individual
Prefix:DR
First Name:IREDELL
Middle Name:WADDELL
Last Name:IGLEHART
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:6301 N CHARLES ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-1047
Mailing Address - Country:US
Mailing Address - Phone:410-372-0300
Mailing Address - Fax:410-372-0304
Practice Address - Street 1:6301 N CHARLES ST
Practice Address - Street 2:SUITE 5
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-1047
Practice Address - Country:US
Practice Address - Phone:410-372-0300
Practice Address - Fax:410-372-0304
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2011-05-02
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Provider Licenses
StateLicense IDTaxonomies
MDD33400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD286881400Medicaid
MD286881400Medicaid