Provider Demographics
NPI:1548676364
Name:BAKALORZ BLUBAUGH, INGRID (DO)
Entity type:Individual
Prefix:
First Name:INGRID
Middle Name:
Last Name:BAKALORZ BLUBAUGH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 S FORGE RD STE 1
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:PA
Mailing Address - Zip Code:17078-9519
Mailing Address - Country:US
Mailing Address - Phone:717-838-1301
Mailing Address - Fax:
Practice Address - Street 1:1400 S FORGE RD STE 1
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:PA
Practice Address - Zip Code:17078-9519
Practice Address - Country:US
Practice Address - Phone:717-838-1301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT 015764207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine