Individual
JAY INGRAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
130 FISHER RD UNIT 1, BERLIN, VT 05602-8132
(802) 371-4100
Mailing address
130 FISHER RD UNIT 1, BERLIN, VT 05602-8132
(802) 371-4100
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
042.0016745
VT
207Q00000X
Family Medicine Physician
35.133104
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0146486
—
OH
Enumeration date
04/06/2015
Last updated
04/05/2023
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