Provider Demographics
NPI:1336121136
Name:CHRISTENBERRY, TAMMY L (MD)
Entity Type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:L
Last Name:CHRISTENBERRY
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:6330 E 75TH ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2717
Mailing Address - Country:US
Mailing Address - Phone:317-588-7130
Mailing Address - Fax:317-588-7150
Practice Address - Street 1:6330 E 75TH ST
Practice Address - Street 2:SUITE 110
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2717
Practice Address - Country:US
Practice Address - Phone:317-588-7130
Practice Address - Fax:317-588-7150
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01051073A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1336121136OtherNPI
IN200338990Medicaid
INH51863Medicare UPIN
IN899980OMedicare PIN