Provider Demographics
NPI:1013018829
Name:INGRAM, MALENE KAY (MD)
Entity Type:Individual
Prefix:
First Name:MALENE
Middle Name:KAY
Last Name:INGRAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 MCCLELLAN ST
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12304-1009
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2125 RIVER RD
Practice Address - Street 2:SUITE 302
Practice Address - City:NISKAYUNA
Practice Address - State:NY
Practice Address - Zip Code:12309-1135
Practice Address - Country:US
Practice Address - Phone:518-243-1313
Practice Address - Fax:518-831-8007
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY241814208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2697149OtherUHC
NY5713U1OtherBLUE CROSS
NY000412313001OtherBSNENY
10115793OtherCDPHP
NY7708835OtherAETNA
NY061214000250OtherFIDELIS CARE
NY396885OtherMVP
NY2697149OtherUHC
NYRB2252Medicare ID - Type Unspecified
NY7708835OtherAETNA