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General NPI Number Information
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NPI Number | 1164084109
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Entity Type | Individual
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Provider Name | CHARLES INGRAM MD
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Gender | Male
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Dates
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Enumeration Date | 06/30/2019
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Last Update Date | 07/23/2024
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Provider Practice Location Address
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Address Line | 2815 S SEACREST BLVD
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City | BOYNTON BEACH
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State | FL
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Zip | 33435-7969
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Country | US
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Telephone | 156-173-7773
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Fax |
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Provider Business Mailing Address
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Address Line | 19444 SATURNIA LAKES DR
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City | BOCA RATON
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State | FL
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Zip | 33498-6206
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 71588
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 207PE0004X
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Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
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License Number | ME169749
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | ME169749
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License Number State | FL
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