Healthcare Provider Details

I. General information

NPI: 1588617021
Provider Name (Legal Business Name): ALEXANDER INGERMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 01/27/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 N LAS PALMAS AVE
LOS ANGELES CA
90038-3515
US

IV. Provider business mailing address

833 N LAS PALMAS AVE
LOS ANGELES CA
90038-3515
US

V. Phone/Fax

Practice location:
  • Phone: 225-773-0474
  • Fax: 225-269-8284
Mailing address:
  • Phone: 225-773-0474
  • Fax: 225-269-8284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberG68271
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number12487R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: