Provider Demographics
NPI:1528037488
Name:BATES, LAURENCE H (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:H
Last Name:BATES
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 1:12188B N MERIDIAN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-4840
Mailing Address - Country:US
Mailing Address - Phone:317-927-5770
Mailing Address - Fax:317-927-5792
Practice Address - Street 1:12188B N MERIDIAN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-4840
Practice Address - Country:US
Practice Address - Phone:317-927-5770
Practice Address - Fax:317-927-5792
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01019540A207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000084987OtherANTHEM
IN100259170Medicaid
4233685OtherAETNA
INB27933Medicare UPIN
000000084987OtherANTHEM
IN256630AMedicare PIN
IN100259170Medicaid
IN830002527Medicare PIN
IN114620FMedicare PIN