Provider Demographics
NPI:1184695470
Name:COMPTON, MARY C (MD)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:C
Last Name:COMPTON
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:PO BOX 358
Mailing Address - Street 2:
Mailing Address - City:TIPTON
Mailing Address - State:IN
Mailing Address - Zip Code:46072-0358
Mailing Address - Country:US
Mailing Address - Phone:765-675-8153
Mailing Address - Fax:765-675-8257
Practice Address - Street 1:406 FAIRGROUNDS RD
Practice Address - Street 2:
Practice Address - City:TIPTON
Practice Address - State:IN
Practice Address - Zip Code:46072-9596
Practice Address - Country:US
Practice Address - Phone:765-675-2429
Practice Address - Fax:765-675-8222
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01027749A207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100233720Medicaid
IN100000316OtherPALMETTO GBA
IN100233720BMedicaid
IN100233720Medicaid
IN100233720BMedicaid
D70778Medicare UPIN
IN810500Medicare PIN