Healthcare Provider Details

I. General information

NPI: 1790841021
Provider Name (Legal Business Name): THOMAS INGEGNO M.S.O.M. , L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 10/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 N CHARLES ST SUITE 204
BALTIMORE MD
21201-5920
US

IV. Provider business mailing address

1800 N CHARLES ST SUITE 204
BALTIMORE MD
21201-5920
US

V. Phone/Fax

Practice location:
  • Phone: 410-842-7784
  • Fax:
Mailing address:
  • Phone: 410-842-7784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberU01495
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number001766
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: