Provider Demographics
NPI:1366414567
Name:INGLETON, ROSEMARIE YVONNE (MD)
Entity type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:YVONNE
Last Name:INGLETON
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 1:14 E 4TH ST
Mailing Address - Street 2:STE 505
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012
Mailing Address - Country:US
Mailing Address - Phone:212-673-7100
Mailing Address - Fax:212-673-6566
Practice Address - Street 1:14 E 4TH ST
Practice Address - Street 2:STE 505
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012
Practice Address - Country:US
Practice Address - Phone:212-673-7100
Practice Address - Fax:212-673-6566
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183798207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
63U591Medicare PIN