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| Type | Person | [sources] | |||
|---|---|---|---|---|---|
| Name | Jacqueline A Ingram | [sources] | |||
| Birth date | not available | [sources] | |||
| Nationality | not available | [sources] | |||
| Country | United States | [sources] | |||
| First name | Jacqueline | [sources] | |||
| Last name | Ingram | [sources] | |||
| Middle name | A | [sources] | |||
| NPI | 1215178785 | [sources] | |||
| Title | Owner | [sources] | |||
| Address | PA, PA | [sources] | |||
| Last change | Last processed | First seen | |||
Medical providers who are precluded from participation in the Medical Assistance Program
United States of America · DHS
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| Address | ||
|---|---|---|
| Full address | Country | |
| PA, PA | United States | |
| Linked to | ||||
|---|---|---|---|---|
| Object | Role | Start date | End date | |
| Beaver Dental Associates, LLC Debarred entity | - | - | - | |