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1932210259
BETHANY INGRAM
VIENNA, VA
NPI
1932210259
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Former Name
BETHANY REVAK
Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
207Q00000X Family Medicine
(Licence: VA 0101226838)
Enumeration Date
2006-08-31
Last Update Date
2007-07-08
Business Address
-- BETHANY INGRAM M.D.
100 MAPLE AVE E
VIENNA, VA 22180-5723
Phone number: 703-938-5300
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Mailing Address
-- BETHANY INGRAM M.D.
100 MAPLE AVE E
VIENNA, VA 22180-5723
Phone number: 703-938-5300
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