MEDICARE: DR. CAROL A IPSEN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	149998	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	362801	OTHER	NY	MVP
2	10000945	OTHER	NY	CDPHP
3	7339593002	OTHER	NY	GHI

General Provider Information

NPI Number	:	1598743445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROL A IPSEN M.D.

Provider Business Mailing Address
First Line	:	1240 NEW SCOTLAND RD
Second Line	:	#204
City	:	SLINGERLANDS
State	:	NY
Zip	:	12159-9222
Country	:	US
Telephone Number	:	518-439-5624
Fax Number	:	518-765-4036

Provider Business Practice Location Address
First Line	:	1240 NEW SCOTLAND RD
Second Line	:	#204
City	:	SLINGERLANDS
State	:	NY
Zip	:	12159-9222
Country	:	US
Telephone Number	:	518-439-5624
Fax Number	:	518-765-4036

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/01/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. CAROL A IPSEN M.D.” Practice Location

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