Provider Demographics
NPI:1811961261
Name:MARCIAL-SCHUSTER, MELITA L (DO)
Entity type:Individual
Prefix:MRS
First Name:MELITA
Middle Name:L
Last Name:MARCIAL-SCHUSTER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2902 E 52ND ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46205-1502
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2902 E 52ND ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-1502
Practice Address - Country:US
Practice Address - Phone:317-259-7296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02004321A207Q00000X
IA3946207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP00770967OtherRR MEDICARE
7929251OtherAETNA
80181936OtherRAILROAD MEDICARE
000000203491OtherANTHEM
04086OtherPARAMOUNT
IA1811961261Medicaid
OH2127871Medicaid
0107374OtherUNITED HEALTHCARE
INP01405439OtherRAILROAD MEDICARE
IN201210030Medicaid
7929251OtherAETNA
IAP00770967OtherRR MEDICARE
IA1811961261Medicaid