1609878149 NPI number — DR. MARIA CAROL POOR MD

Table of content: DR. MARIA CAROL POOR MD (NPI 1609878149)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609878149 NPI number — DR. MARIA CAROL POOR MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POOR
Provider First Name:
MARIA
Provider Middle Name:
CAROL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

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 Information

NPI Number:
1609878149
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/12/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1481 W 10TH ST
Provider Second Line Business Mailing Address:
116P
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46202-2803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1481 W 10TH ST
Provider Second Line Business Practice Location Address:
116P
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46202-2803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-963-7300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  1035288 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100127760 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: CJ7541 . This is a "MEDICARE RR GROUP#" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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