Provider Demographics
NPI:1932198298
Name:DELUMPA, VINCENT B (MD)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:B
Last Name:DELUMPA
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 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8040 CLEARVISTA PARKWAY
Practice Address - Street 2:SUITE 490
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-4673
Practice Address - Country:US
Practice Address - Phone:317-621-5450
Practice Address - Fax:317-621-5453
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01044980208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01347696OtherMEDICARE RR PTAN
IN000000764307OtherANTHEM
IN200105790Medicaid
IN200105790AMedicaid
IN000000764307OtherANTHEM
G29127Medicare UPIN
IN200105790AMedicaid
INM400072782Medicare PIN