Provider Demographics
NPI:1003801952
Name:ANDERSON, CARYN C (MD)
Entity type:Individual
Prefix:DR
First Name:CARYN
Middle Name:C
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5901 TECHNOLOGY CENTER DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-6013
Mailing Address - Country:US
Mailing Address - Phone:317-328-4777
Mailing Address - Fax:317-715-9965
Practice Address - Street 1:5901 TECHNOLOGY CENTER DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46278-6013
Practice Address - Country:US
Practice Address - Phone:317-328-4777
Practice Address - Fax:317-715-9965
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010451572085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN067863OtherSIHO-351158723
INQ0431310OtherCMOSHO351158723-352047427
IN000000492328OtherANTHEM 203778927
IN000000379704OtherANTHEM-351158723
IN200149970Medicaid
IN111288OtherHEALTH ALLIANCE-351158723
INP00275506OtherRRMEDICARE-351158723
IN000000492328OtherANTHEM 203778927
ING60476Medicare UPIN