Provider Demographics
NPI:1912967936
Name:ICE, AMY CAROL (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:CAROL
Last Name:ICE
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 1:20 LEWIS AVENUE
Mailing Address - Street 2:
Mailing Address - City:GT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230
Mailing Address - Country:US
Mailing Address - Phone:413-528-1845
Mailing Address - Fax:413-528-3667
Practice Address - Street 1:20 LEWIS AVENUE
Practice Address - Street 2:
Practice Address - City:GT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230
Practice Address - Country:US
Practice Address - Phone:413-528-1845
Practice Address - Fax:413-528-3667
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2196142084P0800X
NY1906242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
F90312Medicare UPIN
NY65J661Medicare ID - Type Unspecified
MAA36167Medicare ID - Type Unspecified