Provider Demographics
NPI:1255309423
Name:MAGNANTE, DAVID OBER (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:OBER
Last Name:MAGNANTE
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 1:975 MEZZANINE DR STE B
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-8635
Mailing Address - Country:US
Mailing Address - Phone:765-449-7564
Mailing Address - Fax:765-807-7943
Practice Address - Street 1:975 MEZZANINE DR
Practice Address - Street 2:SUITE B
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-8635
Practice Address - Country:US
Practice Address - Phone:765-449-7564
Practice Address - Fax:765-807-7943
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01045133A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00111858OtherMEDICARE RAILROAD NUMBER
IN000000330023OtherANTHEM PROVIDER NUMBER
IN200084030Medicaid
INE47340Medicare UPIN
IN200084030Medicaid