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NPI Code Detail

MEDICARE: DONNA GAIL INGRAM

MEDICARE: DONNA GAIL INGRAM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1376J00000XHomemaker

General Provider Information

NPI Number : 1376148635
Entity Type Code : Individual
Provider Name (Legal Business Name) : DONNA GAIL INGRAM
Provider Business Mailing Address
First Line : 76 CLINE DR
Second Line :
City : CAIRO
State : WV
Zip : 26337-6570
Country : US
Telephone Number : 304-869-4073
Fax Number : 304-471-2488
Provider Business Practice Location Address
First Line : 1222 MARKET ST
Second Line :
City : PARKERSBURG
State : WV
Zip : 26101-4323
Country : US
Telephone Number : 304-865-5420
Fax Number : 304-865-5423
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/03/2020
Last Update Date : 12/03/2020

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Directions to “ DONNA GAIL INGRAM ” Practice Location

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