Basic Information
Provider Information
NPI: 1003801952
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ANDERSON
FirstName: CARYN
MiddleName: C
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5901 TECHNOLOGY CENTER DR
Address2:  
City: INDIANAPOLIS
State: IN
PostalCode: 462786013
CountryCode: US
TelephoneNumber: 3173284777
FaxNumber: 3177159965
Practice Location
Address1: 5901 TECHNOLOGY CENTER DR
Address2:  
City: INDIANAPOLIS
State: IN
PostalCode: 462786013
CountryCode: US
TelephoneNumber: 3173284777
FaxNumber: 3177159965
Other Information
ProviderEnumerationDate: 09/16/2005
LastUpdateDate: 12/11/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0202X01045157INY Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology

ID Information
IDTypeStateIssuerDescription
00000037970401INANTHEM-351158723OTHER
00000049232801INANTHEM 203778927OTHER
11128801INHEALTH ALLIANCE-351158723OTHER
Q043131001INCMOSHO351158723-352047427OTHER
06786301INSIHO-351158723OTHER
20014997005IN MEDICAID
P0027550601INRRMEDICARE-351158723OTHER


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