Provider Demographics
NPI:1316908288
Name:INGIS, THEODORE MARK (MD)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:MARK
Last Name:INGIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:33 RIDDELL ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-2025
Mailing Address - Country:US
Mailing Address - Phone:413-733-2260
Mailing Address - Fax:
Practice Address - Street 1:46 DAGGETT DR
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-4638
Practice Address - Country:US
Practice Address - Phone:413-733-2260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA41139207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2089009Medicaid
MA2089009Medicaid
MAA67751Medicare UPIN