Provider Demographics
NPI:1851376230
Name:PAIRITZ, ANITA R (MD)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:R
Last Name:PAIRITZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANITA
Other - Middle Name:
Other - Last Name:GLASSON
Other - Suffix:
Other - Last Name Type:Former Name
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 1:714 N SENATE AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-3763
Practice Address - Country:US
Practice Address - Phone:317-963-5582
Practice Address - Fax:317-968-1485
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361656812084P0800X
IN01042871A2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100381800Medicaid
IN798900 CCMedicare ID - Type Unspecified
INP01002395Medicare PIN
IN100381800Medicaid
INM400046745Medicare PIN