Healthcare Provider Details

I. General information

NPI: 1275861817
Provider Name (Legal Business Name): REBECCA HARDING INGRAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2009
Last Update Date: 11/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 MAPLE TREE LN
SPRING GROVE VA
23881-8515
US

IV. Provider business mailing address

316 MAPLE TREE LN
SPRING GROVE VA
23881-8515
US

V. Phone/Fax

Practice location:
  • Phone: 757-866-8688
  • Fax: 757-866-8688
Mailing address:
  • Phone: 757-866-8688
  • Fax: 757-866-8688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number0101242147
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: