Healthcare Provider Details

I. General information

NPI: 1124027438
Provider Name (Legal Business Name): MARY CHAMBERS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4225 VICKERS DR
COLUMBUS IN
47203-4649
US

IV. Provider business mailing address

4225 VICKERS DR
COLUMBUS IN
47203-4649
US

V. Phone/Fax

Practice location:
  • Phone: 812-379-9524
  • Fax:
Mailing address:
  • Phone: 812-379-9524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01053292A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: