Provider Demographics
NPI:1659312387
Name:VORWALD, MARYJEAN (MD)
Entity Type:Individual
Prefix:
First Name:MARYJEAN
Middle Name:
Last Name:VORWALD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 N MERIDIAN ST
Mailing Address - Street 2:STE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204-3908
Mailing Address - Country:US
Mailing Address - Phone:317-962-4945
Mailing Address - Fax:317-962-4950
Practice Address - Street 1:1650 W OAK ST
Practice Address - Street 2:STE 104
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-3835
Practice Address - Country:US
Practice Address - Phone:317-873-8910
Practice Address - Fax:317-873-8821
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01035258207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100335210Medicaid
INP00844435Medicare PIN
INM400015263Medicare PIN
IN100335210Medicaid
IND95721Medicare UPIN