MEDICARE: ROBERT INGRAM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	0000-27603	NC
2	208M00000X	Hospitalist Physician	0101263283	VA

General Provider Information

NPI Number	:	1881743896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT INGRAM M.D.

Provider Business Mailing Address
First Line	:	3400 WAKE FOREST RD
Second Line	:	DHRH INPATIENT MEDICAL SERVICE
City	:	RALEIGH
State	:	NC
Zip	:	27609-7317
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	PO BOX 430
Second Line	:
City	:	ONANCOCK
State	:	VA
Zip	:	23417-0430
Country	:	US
Telephone Number	:	757-302-2100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	03/17/2018

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