Provider Demographics
NPI:1689693889
Name:ABBOTT, TROY A (MD)
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:A
Last Name:ABBOTT
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:
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 1:2901 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-4307
Practice Address - Country:US
Practice Address - Phone:765-281-6920
Practice Address - Fax:765-281-6151
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01041641A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000312982OtherANTHEM
INP00099379OtherRR MEDICARE
ININ1868004OtherMEDICARE
IN100374730Medicaid
INM400029001Medicare PIN
IN213390AMedicare PIN
INM400046002Medicare PIN