Provider Demographics
NPI:1164691085
Name:SAMPSON, MAUREEN E (MD)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:E
Last Name:SAMPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 E. 75TH STREET
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2790
Mailing Address - Country:US
Mailing Address - Phone:317-621-1303
Mailing Address - Fax:317-621-1310
Practice Address - Street 1:13121 OLIO ROAD
Practice Address - Street 2:SUITE 300
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-7240
Practice Address - Country:US
Practice Address - Phone:317-621-1300
Practice Address - Fax:317-621-1310
Is Sole Proprietor?:No
Enumeration Date:2008-02-25
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01067225A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000639909OtherANTHEM
IN200958820Medicaid
IN9409431OtherAETNA
INP01061524OtherMEDICARE RR
IN200958820Medicaid
IN000000639909OtherANTHEM