Provider Demographics
NPI:1194794966
Name:INGARD, JOHN U (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:U
Last Name:INGARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 WORCESTER ST
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-5420
Mailing Address - Country:US
Mailing Address - Phone:781-431-5440
Mailing Address - Fax:
Practice Address - Street 1:230 WORCESTER ST
Practice Address - Street 2:INTERNAL MEDICINE
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-5420
Practice Address - Country:US
Practice Address - Phone:781-431-5420
Practice Address - Fax:781-431-5465
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA46298207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA046298OtherTUFTS
MA3047342Medicaid
MAPM268OtherHARVARD PILGRIM
MAJ02549OtherBLUE CROSS
MA3047342Medicaid
MAJ02549OtherBLUE CROSS