Healthcare Provider Details

I. General information

NPI: 1801327200
Provider Name (Legal Business Name): PHILIP CARTER WHARTON M.D,
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 07/12/2021
Certification Date: 07/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 W 10TH ST
INDIANAPOLIS IN
46202-3082
US

IV. Provider business mailing address

2001 W 86TH ST
INDIANAPOLIS IN
46260-1902
US

V. Phone/Fax

Practice location:
  • Phone: 317-274-8157
  • Fax:
Mailing address:
  • Phone: 317-338-6399
  • Fax: 317-338-6359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number01083324A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: