Provider Demographics
NPI:1598743445
Name:IPSEN, CAROL A (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:A
Last Name:IPSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 NEW SCOTLAND RD
Mailing Address - Street 2:#204
Mailing Address - City:SLINGERLANDS
Mailing Address - State:NY
Mailing Address - Zip Code:12159-9222
Mailing Address - Country:US
Mailing Address - Phone:518-439-5624
Mailing Address - Fax:518-765-4036
Practice Address - Street 1:1240 NEW SCOTLAND RD
Practice Address - Street 2:#204
Practice Address - City:SLINGERLANDS
Practice Address - State:NY
Practice Address - Zip Code:12159-9222
Practice Address - Country:US
Practice Address - Phone:518-439-5624
Practice Address - Fax:518-765-4036
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1499982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY362801OtherMVP
NY10000945OtherCDPHP
NY7339593002OtherGHI
NY10000945OtherCDPHP
NY7339593002OtherGHI