Healthcare Provider Details

I. General information

NPI: 1730164856
Provider Name (Legal Business Name): KATHLEEN M. INGWERSEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LANDSTUHL REGIONAL MEDICAL CENTER CMR 402
APO AE
09180
DE

IV. Provider business mailing address

LANDSTUHL REGIONAL MEDICAL CENTER CMR 402; BOX 2059
APO AE
09180
DE

V. Phone/Fax

Practice location:
  • Phone: 011491622700861
  • Fax: 011496371867071
Mailing address:
  • Phone: 011496371866781
  • Fax: 011496371867071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License NumberMD 6710
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: