Individual
MARY CICCARELLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2505 N ARLINGTON AVE, INDIANAPOLIS, IN 46218-3318
(317) 554-5200
(317) 554-5247
Mailing address
PO BOX 719094, CHICAGO, IL 60677-9318
(317) 777-6435
(317) 777-6644
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01039620A
IN
208000000X
Pediatrics Physician
01039620A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000086725
ANTHEM
IN
05
—
100117410
—
IN
Enumeration date
04/27/2006
Last updated
02/13/2026
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