Basic Information
Provider Information | |||||||||
NPI: | 1366451338 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | INGERSOLL | ||||||||
FirstName: | FRANCIS | ||||||||
MiddleName: | W | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: | III | ||||||||
Credential: | DO | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 370 FAUNCE CORNER ROAD | ||||||||
Address2: | SOUTHCOAST PHYSICIAN SERVICES INC | ||||||||
City: | NO DARTMOUTH | ||||||||
State: | MA | ||||||||
PostalCode: | 02747 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5089852000 | ||||||||
FaxNumber: | 5089852001 | ||||||||
Practice Location | |||||||||
Address1: | 101 PAGE STREET | ||||||||
Address2: | SOUTHCOAST PHYSICIAN SERVICES INC | ||||||||
City: | NEW BEDFORD | ||||||||
State: | MA | ||||||||
PostalCode: | 02740 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5089615919 | ||||||||
FaxNumber: | 5089615916 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/07/2006 | ||||||||
LastUpdateDate: | 03/08/2010 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 160595 | MA | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207R00000X | DO00506 | RI | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
No ID Information.