MEDICARE: DANIEL WAYNE INGRAM PA C

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
1	363A00000X	Physician Assistant	102777	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750356192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL WAYNE INGRAM PA C

Provider Business Mailing Address
First Line	:	4207 LAKE BOONE TRL
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27607-6684
Country	:	US
Telephone Number	:	919-784-1410
Fax Number	:

Provider Business Practice Location Address
First Line	:	4207 LAKE BOONE TRL
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27607
Country	:	US
Telephone Number	:	919-785-3400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	03/29/2021

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