Provider Demographics
NPI:1356439830
Name:AMBLER, DENISSE (MD)
Entity type:Individual
Prefix:
First Name:DENISSE
Middle Name:
Last Name:AMBLER
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:DENISSE
Other - Middle Name:
Other - Last Name:MARION-LANDAIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3620 W WHITE RIVER BLVD
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-4286
Practice Address - Country:US
Practice Address - Phone:919-933-2000
Practice Address - Fax:919-933-4148
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0099-014372084P0800X
IN01074464A2084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000001618326OtherANTHEM PTAN
IN201245550Medicaid
NC89134TWMedicaid
NC2280906AMedicare ID - Type Unspecified