Provider Demographics
NPI:1215000484
Name:WASHINGTON, PHELGAR DELANO (MD)
Entity Type:Individual
Prefix:
First Name:PHELGAR
Middle Name:DELANO
Last Name:WASHINGTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3737 N MERIDIAN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46208-4348
Mailing Address - Country:US
Mailing Address - Phone:317-925-2661
Mailing Address - Fax:317-925-2662
Practice Address - Street 1:3737 N MERIDIAN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46208-4348
Practice Address - Country:US
Practice Address - Phone:317-925-2661
Practice Address - Fax:317-925-2662
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01040622207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100120930AMedicaid
278090Medicare ID - Type Unspecified
IN1215000484Medicare NSC
F34026Medicare UPIN