MEDICARE: MARY L MAYER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0000X	Hematology (Internal Medicine) Physician	01040769A	IN
2	207RX0202X	Medical Oncology Physician	01040769A	IN
3	207RH0003X	Hematology & Oncology Physician	01040769A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P01751205	OTHER	IN	RR MEDICARE
7	P01456909	OTHER	IN	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2048872	OTHER	IN	CIGNA
2	000000902313	OTHER	IN	ANTHEM
4	000000092001	OTHER	IN	ANTHEM BCBS
5	4323595	OTHER	IN	AETNA
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770588808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY L MAYER MD

Provider Business Mailing Address
First Line	:	6626 E 75TH ST STE 500
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-2890
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7979 N SHADELAND AVE
Second Line	:	STE 200
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-2042
Country	:	US
Telephone Number	:	317-621-4300
Fax Number	:	317-621-4301

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	09/06/2023

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Directions to “ MARY L MAYER MD” Practice Location

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