Provider Demographics
NPI:1407820046
Name:HENAR, INGRID Y (MD)
Entity type:Individual
Prefix:MS
First Name:INGRID
Middle Name:Y
Last Name:HENAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:INGRID
Other - Middle Name:Y
Other - Last Name:HENAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:INGRID HENAR MD/SOUTH COVE COMMUNITY HEALTH CENTER
Mailing Address - Street 2:277 COMMERCIAL STREET
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148
Mailing Address - Country:US
Mailing Address - Phone:617-253-1505
Mailing Address - Fax:
Practice Address - Street 1:SOUTH COVE COMMUNITY CENTER
Practice Address - Street 2:277 COMMERCIAL STREET
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148
Practice Address - Country:US
Practice Address - Phone:617-253-1505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA51855208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ08794OtherBLUE CROSS
MA110060594AMedicaid
MAJ08794Medicare ID - Type Unspecified