Provider Demographics
NPI:1821267873
Name:BEHRAD, MARINA (MD)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:BEHRAD
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 1:10649 BENNETT PKWY
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-7849
Mailing Address - Country:US
Mailing Address - Phone:317-873-6700
Mailing Address - Fax:
Practice Address - Street 1:10649 BENNETT PKWY
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-7849
Practice Address - Country:US
Practice Address - Phone:317-873-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-25
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01065336A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000570800OtherANTHEM
IN200988440Medicaid
INM400034723Medicare PIN
IN313600P4Medicare PIN
INM400030101Medicare PIN
IN200988440Medicaid
INM400030098Medicare PIN
IN215140GMedicare PIN
IN000000570800OtherANTHEM
INM400046041Medicare PIN