Provider Demographics
NPI:1932213204
Name:GORRIE, MARK C (DO)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:C
Last Name:GORRIE
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:250 N SHADELAND AVENUE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:317-963-0860
Mailing Address - Fax:
Practice Address - Street 1:714 N. SENATE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-3297
Practice Address - Country:US
Practice Address - Phone:317-944-1837
Practice Address - Fax:317-715-6415
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL361138132085R0202X
IN02003492A2085R0202X
FLOS182372085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00787056OtherRAILROAD MEDICARE
FL112658900Medicaid
IN000000618591OtherANTHEM BCBS
IN200946010Medicaid
INP00787056OtherRAILROAD MEDICARE