Provider Demographics
NPI:1053301143
Name:MAYLOCK, CAROLINE ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:ANN
Last Name:MAYLOCK
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:8555 ONE WEST DR
Mailing Address - Street 2:APT 208
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5392
Mailing Address - Country:US
Mailing Address - Phone:317-726-0974
Mailing Address - Fax:
Practice Address - Street 1:8111 TOWNSHIP LINE RD
Practice Address - Street 2:ST VINCENT'S WOMEN'S HOSPITAL DEPT OF NEONATOLOGY
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2479
Practice Address - Country:US
Practice Address - Phone:317-415-7921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
PAMD 056891L2080N0001X
IN01061580A2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1053301143Medicare UPIN