Active NPI
Ingeborg Krompholz Damstra, M.D.
- Child & Adolescent Psychiatry Physician
- Paoli, PA
National Provider Identifier
1689883241
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Child & Adolescent Psychiatry Physician
- License
- MD053665L
- Practice address
- 171 W Lancaster Ave
Council for Relationships
Paoli, PA 19301-1775 - Phone
- (610) 889-0419
- NPI assigned
- May 21, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Child & Adolescent Psychiatry Physician | 2084P0804X | MD053665L | PA | Primary |
Addresses
Primary practice location
171 W Lancaster Ave
Council for Relationships
Paoli, PA 19301-1775
Mailing address
47 Dunminning Rd
Newtown Square, PA 19073-1801
Phone (610) 254-9238
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective May 28, 2024 through May 28, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD053665L | PA | MD | Child & Adolescent Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179705600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1689883241",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "47 DUNMINNING RD",
"city": "NEWTOWN SQUARE",
"state": "PA",
"postal_code": "190731801",
"telephone_number": "610-254-9238"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "171 W LANCASTER AVE",
"address_2": "COUNCIL FOR RELATIONSHIPS",
"city": "PAOLI",
"state": "PA",
"postal_code": "193011775",
"telephone_number": "610-889-0419"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAMSTRA",
"first_name": "INGEBORG",
"middle_name": "KROMPHOLZ",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-21",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0804X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
"state": "PA",
"license": "MD053665L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Paoli, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.