Healthcare Provider Details

I. General information

NPI: 1205035516
Provider Name (Legal Business Name): AILEEN INGAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2007
Last Update Date: 06/18/2021
Certification Date: 06/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 ASYLUM AVE STE 2108
HARTFORD CT
06105-1719
US

IV. Provider business mailing address

701 MEDICAL PARK DR STE 208
HARTSVILLE SC
29550-4777
US

V. Phone/Fax

Practice location:
  • Phone: 860-714-4097
  • Fax: 860-714-8001
Mailing address:
  • Phone: 843-383-5191
  • Fax: 843-383-0115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number60210
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number60210
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: