Provider Demographics
NPI:1356324453
Name:PISC, CARMEN L (MD)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:L
Last Name:PISC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CARMEN
Other - Middle Name:L
Other - Last Name:MAIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2401 W UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-3428
Practice Address - Country:US
Practice Address - Phone:765-281-2030
Practice Address - Fax:765-448-7667
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA208254207RH0003X
PAMD435505207RX0202X
WY9491A207RX0202X
CT63480207RX0202X
IN01091171A207RX0202X, 207RH0003X
MDD83526207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA208254OtherTUFTS HEALTH CARE
CT008088213Medicaid
PA1022897800001Medicaid
MAAA14188OtherHARVARD PILGRIM
MAJ24402OtherBLUE CROSS BLUE SHIELD
MA153940Medicaid
IN300080355Medicaid
NH30204573Medicaid
MA5033388001OtherCIGNA
INM12240477OtherMEDICARE PTAN
MA2664150OtherAETNA US HEALTH
PA002070762OtherHIGHMARK
PAP00659590Medicare PIN
MA208254OtherTUFTS HEALTH CARE
PAH50395Medicare UPIN
PA138022Medicare PIN