Provider Demographics
NPI:1144491101
Name:INGRAM, ABBIE LYNN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ABBIE
Middle Name:LYNN
Last Name:INGRAM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 WARREN RD
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-5962
Mailing Address - Country:US
Mailing Address - Phone:617-466-9506
Mailing Address - Fax:
Practice Address - Street 1:75 FRANCIS ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6110
Practice Address - Country:US
Practice Address - Phone:617-983-4537
Practice Address - Fax:617-983-4534
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-18
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAAP2485363A00000X
MABOH-22-BAP-02246ZA2600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZA2600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherArt, Medical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant