Individual
CARLA MARIE BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
6640 INTECH BLVD STE 195, INDIANAPOLIS, IN 46278-2014
(317) 295-0608
(317) 948-0609
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
01087770A
IN
2084P0800X
Psychiatry Physician
01087770A
IN
2084P0800X
Psychiatry Physician
310168
LA
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
01087770A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1102529646
ANTHEM PTAN
IN
05
—
300062282
—
IN
Enumeration date
05/02/2016
Last updated
05/15/2025
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