Provider Demographics
NPI: | 1255389334 |
---|---|
Name: | ORR, DONALD P (MD) |
Entity type: | Individual |
Prefix: | |
First Name: | DONALD |
Middle Name: | P |
Last Name: | ORR |
Suffix: | |
Gender: | M |
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 1026 |
Mailing Address - Street 2: | |
Mailing Address - City: | INDIANAPOLIS |
Mailing Address - State: | IN |
Mailing Address - Zip Code: | 46206-1026 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 317-274-1201 |
Mailing Address - Fax: | 317-278-9905 |
Practice Address - Street 1: | 705 RILEY HOSPITAL DR |
Practice Address - Street 2: | MSA 2 |
Practice Address - City: | INDIANAPOLIS |
Practice Address - State: | IN |
Practice Address - Zip Code: | 46202-5109 |
Practice Address - Country: | US |
Practice Address - Phone: | 317-274-8812 |
Practice Address - Fax: | 317-274-0133 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-05-04 |
Last Update Date: | 2011-04-01 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
IN | 01032460A | 208000000X |
IN | 01032460 | 2080A0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2080A0000X | Allopathic & Osteopathic Physicians | Pediatrics | Adolescent Medicine |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
IN | 100073710 | Medicaid | |
IN | 100073710 | Medicaid | |
IN | C04179 | Medicare UPIN | |
145590ZZ | Medicare PIN |