Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 262870 | NY |
NPI | 1003071341 |
---|---|
Provider Name | Dr. Michael Thomas Ingoglia |
First Address | Fairfax, VA 22033-2921 |
Second Address | Poughkeepsie, NY 12601-3947 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2008 |
Last Update Date | 03/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03382661 | (05) | NY |
J400056247 | MEDICARE (01) | NY |