Provider Demographics
NPI:1477636371
Name:MARIASH, CARY N (MD)
Entity Type:Individual
Prefix:DR
First Name:CARY
Middle Name:N
Last Name:MARIASH
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 1:250 N SHADELAND AVE
Mailing Address - Street 2:STE 130 PROVIDER ENROLLMENT
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 1:201 PENNSYLVANIA PKWY
Practice Address - Street 2:STE 310
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46280-2301
Practice Address - Country:US
Practice Address - Phone:317-813-0000
Practice Address - Fax:317-573-4064
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN20921207R00000X, 207RE0101X
IN01065821207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200929970Medicaid
33-70016OtherMEDICA PRIMARY
1009230OtherPREFERRED ONE
HP22058OtherHEALTH PARTNERS
MT0064889Medicaid
2T162MAOtherBLUE CROSS BLUE SHIELD
3324572OtherMEDICA CHOICE
MN738798900Medicaid
644606OtherARAZ
101018OtherUCARE
460000036Medicare PIN
IN200929970Medicaid
INP00859170Medicare PIN
HP22058OtherHEALTH PARTNERS
3324572OtherMEDICA CHOICE
2T162MAOtherBLUE CROSS BLUE SHIELD