Provider Demographics
NPI:1215948062
Name:INGRAM, TERRI L (MD)
Entity type:Individual
Prefix:DR
First Name:TERRI
Middle Name:L
Last Name:INGRAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:938 BANNOCK ST
Mailing Address - Street 2:STE 300
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-4028
Mailing Address - Country:US
Mailing Address - Phone:303-914-8800
Mailing Address - Fax:303-716-3777
Practice Address - Street 1:938 BANNOCK ST
Practice Address - Street 2:STE 300
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-4028
Practice Address - Country:US
Practice Address - Phone:303-914-8800
Practice Address - Fax:303-716-3777
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO308532085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01308535Medicaid
CO008551OtherKAISER COMMERCIAL NUMBER
COCO306396Medicare PIN
COCH9718Medicare PIN
COC803975Medicare PIN
CO300081074Medicare PIN
COP00621379Medicare PIN
CO01308535Medicaid
COC801370Medicare PIN
COC801369Medicare PIN
COE36293Medicare UPIN
COC803977Medicare PIN
CO008551OtherKAISER COMMERCIAL NUMBER