Healthcare Provider Details

I. General information

NPI: 1750575692
Provider Name (Legal Business Name): DREW CHRISTIAN INGRAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2007
Last Update Date: 04/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 V ST STE 3116
SACRAMENTO CA
95817-1460
US

IV. Provider business mailing address

1580 CREEKSIDE DR STE 220
FOLSOM CA
95630-3888
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-7080
  • Fax:
Mailing address:
  • Phone: 916-983-4444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA101346
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: