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1700889623

NPI Code Detail

MEDICARE: DR. EDWARD R BARTLEY MD

MEDICARE: DR. EDWARD R BARTLEY 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	2085R0202X	Diagnostic Radiology Physician	01026192A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	300100619	OTHER	IN	RR MEDICARE 351158723

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	071674	OTHER	IN	HEALTH ALLIANCE-351158723
3	000000492330	OTHER	IN	ANTHEM 203778927
4	000000082139	OTHER	IN	ANTHEM-351158723
5	002857	OTHER	IN	SIHO-351158723
7	Q0072450	OTHER	IN	CMOSHO351158723&352047427

General Provider Information

NPI Number	:	1700889623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD R BARTLEY MD

Provider Business Mailing Address
First Line	:	5901 TECHNOLOGY CENTER DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46278-6013
Country	:	US
Telephone Number	:	317-328-4777
Fax Number	:	317-715-9965

Provider Business Practice Location Address
First Line	:	5901 TECHNOLOGY CENTER DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46278-6013
Country	:	US
Telephone Number	:	317-328-4777
Fax Number	:	317-715-9965

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	12/04/2009

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Directions to “ DR. EDWARD R BARTLEY MD” Practice Location

Language	Start Address	Practice Location

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