Provider Demographics
NPI:1184835951
Name:SGROI, MADELAINE M (DO)
Entity Type:Individual
Prefix:DR
First Name:MADELAINE
Middle Name:M
Last Name:SGROI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MADELAINE
Other - Middle Name:
Other - Last Name:MIRANDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8890 JULES LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-9557
Mailing Address - Country:US
Mailing Address - Phone:317-514-2185
Mailing Address - Fax:
Practice Address - Street 1:329 MAINE ST STE 101
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-3310
Practice Address - Country:US
Practice Address - Phone:207-373-2266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002971207R00000X
IN02002971A207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200816200Medicaid
INM400056858Medicare PIN