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Individual

CARINA THEA MARCELLA DAVID

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
1520 N SENATE AVE, RM 230, INDIANAPOLIS, IN 46202-2213
(317) 962-0897
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01081787A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
068010526
MEDICARE PTAN
IN
05
201372730
IN
01
P02456765
RAILROAD PTAN
IN
Enumeration date
05/12/2016
Last updated
12/04/2023
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