Provider Demographics
NPI:1255345120
Name:CROVELLO, JOY (MD)
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:CROVELLO
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 1:3903 HAVERHILL DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-3651
Mailing Address - Country:US
Mailing Address - Phone:317-578-1215
Mailing Address - Fax:
Practice Address - Street 1:3903 HAVERHILL DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-3651
Practice Address - Country:US
Practice Address - Phone:317-578-1215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01041663A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000320777OtherANTHEM
IN200038740Medicaid
INP01157326OtherMEDICARE RR
INF46766Medicare UPIN
INP00222715Medicare PIN
INP01157326OtherMEDICARE RR