Provider Demographics
NPI:1942283510
Name:CUDIAMAT, MARIA CARMEN (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:CARMEN
Last Name:CUDIAMAT
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 1:1 MEMORIAL SQ STE 50
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-1357
Mailing Address - Country:US
Mailing Address - Phone:317-468-6270
Mailing Address - Fax:317-468-6268
Practice Address - Street 1:120 W MCKENZIE RD STE H
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-1072
Practice Address - Country:US
Practice Address - Phone:317-462-2335
Practice Address - Fax:317-462-2069
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060435A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200311740OtherMEDICAID GROUP #
IN5717399OtherAETNA PIN#
IN000000383143OtherANTHEM PIN#
IN200544230Medicaid
ING38180Medicare UPIN
IN200544230Medicaid