| Doctor Name: | BRADLEY INGRAM |
| NPI Number: | 1144290321 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PAC |
| License Number: | C0003519 |
| Business Practice Address: | 22911 Jefferson Blvd Smithsburg, MD - 217831617 |
| Business Phone Number: | 3018243343 |
| Business Fax Number: | 3018246323 |
| Mailing Address: | 11110 Medical Campus Rd, Suite 229 HAGERSTOWN |
| State: | MD |
| Postal Code: | 217426700 |
| Phone Number: | 3016654526 |
| Fax Number: | 3016654521 |
| NPI Enumeration Date: | 01/23/2006 |
| NPI Last Update Date: | 07/10/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | C0003519 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |