1982538518 NPI number — MR. ROILAN HERMARION INGRAM SR. 171M00000X

Table of content: MR. ROILAN HERMARION INGRAM SR. 171M00000X (NPI 1982538518)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982538518 NPI number — MR. ROILAN HERMARION INGRAM SR. 171M00000X

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
INGRAM
Provider First Name:
ROILAN
Provider Middle Name:
HERMARION
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
SR.
Provider Credential Text:
171M00000X
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982538518
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/09/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3618 CHAMBERLAND DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76014-3118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-824-8100
Provider Business Mailing Address Fax Number:
972-824-8100

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3618 CHAMBERLAND DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76014-3118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-824-8100
Provider Business Practice Location Address Fax Number:
972-824-8100
Provider Enumeration Date:
06/09/2026

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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