1477636371 NPI number — DR. CARY N MARIASH MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477636371 NPI number — DR. CARY N MARIASH MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

MARIASH

Provider First Name:

CARY

Provider Middle Name:

N

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1477636371

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

01/14/2021

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

250 N SHADELAND AVE

Provider Second Line Business Mailing Address:

STE 130 PROVIDER ENROLLMENT

Provider Business Mailing Address City Name:

INDIANAPOLIS

Provider Business Mailing Address State Name:

IN

Provider Business Mailing Address Postal Code:

46219-4959

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

201 PENNSYLVANIA PKWY

Provider Second Line Business Practice Location Address:

STE 310

Provider Business Practice Location Address City Name:

INDIANAPOLIS

Provider Business Practice Location Address State Name:

IN

Provider Business Practice Location Address Postal Code:

46280-2301

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

317-813-0000

Provider Business Practice Location Address Fax Number:

317-573-4064

Provider Enumeration Date:

10/23/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207R00000X , with the licence number:  20921 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207RE0101X , with the licence number: 20921 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207RE0101X , with the licence number: 01065821 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 200929970 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
• Identifier: 33-70016 . This is a "MEDICA PRIMARY" identifier . This identifiers is of the category "OTHER".
• Identifier: 1009230 . This is a "PREFERRED ONE" identifier . This identifiers is of the category "OTHER".
• Identifier: HP22058 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
• Identifier: 0064889 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
• Identifier: 2T162MA . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
• Identifier: 3324572 . This is a "MEDICA CHOICE" identifier . This identifiers is of the category "OTHER".
• Identifier: 738798900 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
• Identifier: 644606 . This is a "ARAZ" identifier . This identifiers is of the category "OTHER".
• Identifier: 101018 . This is a "UCARE" identifier . This identifiers is of the category "OTHER".