Provider Demographics
NPI:1366616047
Name:MADERO, INGRID CAROLINA (MD)
Entity type:Individual
Prefix:DR
First Name:INGRID
Middle Name:CAROLINA
Last Name:MADERO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:INGRID
Other - Middle Name:CAROLINA
Other - Last Name:HERNANDEZ SELMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:100 KINGS HWY S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5504
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 COULTER RD FL 2
Practice Address - Street 2:
Practice Address - City:CLIFTON SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:14432-1122
Practice Address - Country:US
Practice Address - Phone:315-462-2000
Practice Address - Fax:315-462-6373
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2642722084P0804X, 2084P0800X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry