Healthcare Provider Details

I. General information

NPI: 1508905548
Provider Name (Legal Business Name): JOHN WALTER INGLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 09/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2365 CLINTON AVE S SUITE 200
ROCHESTER NY
14618-2663
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX 629
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-758-5700
  • Fax: 585-758-1299
Mailing address:
  • Phone: 585-758-5700
  • Fax: 585-758-1299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number2006-0352
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD442128
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number271897
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: