BRADLEY INGRAM (NPI# 1144290321) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1144290321 |
| Entity Type | Individual |
| Full Name | BRADLEY INGRAM |
| Credential | PAC |
| Practice Address |
22911 Jefferson Blvd Smithsburg MD 21783-1617 |
| Mailing Address |
11110 Medical Campus Rd Suite 229 Hagerstown MD 21742-6700 |
| Practice Telephone | 3018243343 |
| Practice Fax Number | 3018246323 |
| Mailing Telephone | 3016654526 |
| Mailing Fax Number | 3016654521 |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2020-06-29 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363AM0700X |
Physician Assistant Specialization: Medical |
0110001879 | VA | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
C0003519 | MD | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | VA-DEA | MI5599329 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1440 Amherst St, Winchester, VA 226013010 | 5405365400 | 5405365490 |
| 22911 Jefferson Blvd, Smithsburg, MD 217831617 | 3018243343 | 3018246323 |
| Street Address |
22911 JEFFERSON BLVD |
| City | SMITHSBURG |
| State | MD |
| Zip Code | 21783-1617 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376524447 | Jennifer Lynn Nunnelee | Physician Assistant | 22911 Jefferson Blvd, Smithsburg, MD 21783-1617 | 2005-11-07 |
| 1316508773 | Taylor B James | Physician Assistant | 22911 Jefferson Blvd, Smithsburg, MD 21783-1617 | 2019-06-26 |
| 1801379490 | Bryan Jeffrey Peralta | Nurse Practitioner | 22911 Jefferson Blvd, Smithsburg, MD 21783-1617 | 2018-09-11 |
| 1851790232 | Mary Catherine Buntin | Physician Assistant | 22911 Jefferson Blvd, Smithsburg, MD 21783-1617 | 2014-08-21 |
| 1407173610 | Dipti Mohanlal Mistry | Internal Medicine | 22911 Jefferson Blvd, Smithsburg, MD 21783-1617 | 2010-04-27 |
| 1326003666 | William B Kerns | Internal Medicine | 22911 Jefferson Blvd, Smithsburg, MD 21783-1617 | 2006-04-19 |
| 1861457079 | Gail M Callaway | Internal Medicine | 22911 Jefferson Blvd, Smithsburg, MD 21783-1617 | 2006-04-19 |
| 1366407975 | Brian K. Bonham | Internal Medicine | 22911 Jefferson Blvd, Smithsburg, MD 21783-1617 | 2006-04-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699853960 | Thomas M Nussear | Dentist | 40 South Main Street, Smithsburg, MD 21783 | 2006-11-02 |
| 1508263971 | Ryann Shay Frye | Specialist/Technologist | 66 N Main St, Smithsburg, MD 21783 | 2014-12-01 |
| 1184249567 | Kirsten Helman | Specialist/Technologist | 23327 Ringgold Pike, Smithsburg, MD 21783-1114 | 2020-06-11 |
| 1669653515 | Stephen S. Lippman, M.d., Ph.d., P.a. | Internal Medicine | 13538 Edgemont Rd, Smithsburg, MD 21783-1243 | 2007-11-20 |
| 1699957118 | Lawrence Alan Jones | Urology | 12835 Unger Rd, Smithsburg, MD 21783-1305 | 2007-11-27 |
| 1073931671 | Michelle Lane | Social Worker | 40 Byron Dr, Smithsburg, MD 21783-1565 | 2014-04-01 |
| 1497094601 | Tami O Young | Occupational Therapy Assistant | 105 Gabriel Ct, Smithsburg, MD 21783-1574 | 2013-02-07 |
| 1306191465 | Faye A. Kimmons | Technician, Pathology | 112 Colton Ct, Smithsburg, MD 21783-1594 | 2012-07-16 |
| 1629277157 | Kemsha Ziggy Taffari Huslin | Internal Medicine | 22128 Whitestone Ct, Smithsburg, MD 21783-1596 | 2007-07-14 |
| 1013392745 | Linda Potts | Homeopath | 38 E Water St, Smithsburg, MD 21783-1604 | 2015-07-23 |
| Find all providers in zip 21783 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336767227 | Merlyn Angella Boakai | Physician Assistant | 800 Sero Pine Ln, Fort Washington, MD 20744-5954 | 2020-07-08 |
| 1831730878 | Jennifer Bacher | Physician Assistant | 1185 Imperial Dr Ste 201, Hagerstown, MD 21740-6673 | 2019-10-01 |
| 1831747971 | Miriam Noelle Meiser | Physician Assistant | 10750 Columbia Pike Unit 401a, Silver Spring, MD 20901-4402 | 2019-09-02 |
| 1285296913 | Mary Furda | Physician Assistant | 20680 Seneca Meadows Pkwy Ste 206, Germantown, MD 20876 | 2019-07-02 |
| 1902466998 | Christina Deleon | Physician Assistant | 403 Marvel Court, Easton, MD 21601 | 2019-06-20 |
| 1467012369 | Molly Uebele Harrigan | Physician Assistant | 5225 Pooks Hill Rd Apt 1007n, Bethesda, MD 20814-2041 | 2019-06-13 |
| 1558834234 | Kevin Timothy Johnson | Physician Assistant | 411 Naylor Mill Rd, Salisbury, MD 21801-1191 | 2019-01-06 |
| 1093287260 | Carolina Radzyminska Johnson | Physician Assistant | 10750 Columbia Pike Ste 401, Silver Spring, MD 20901-4402 | 2018-12-27 |
| 1962971309 | Emmy L Estrada | Physician Assistant | 12150 Annapolis Rd Ste 208, Glenn Dale, MD 20769-9183 | 2018-11-14 |
| 1982170833 | Barbara Argyros | Physician Assistant | 1415 S. Mountain Road, Suite 100, Joppa, MD 21085 | 2018-10-18 |
| Find all providers with the same taxonomy | ||||
| City | SMITHSBURG |
| Zip Code | 21783 |
Please comment or provide details below to improve the information on BRADLEY INGRAM.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.