Provider Demographics
NPI:1518901230
Name:SCAMARDO-MITCHELL, MARY C (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:C
Last Name:SCAMARDO-MITCHELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:C
Other - Last Name:SCAMARDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:133 CARLIN DR
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-2228
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:133 CARLIN DR
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-2228
Practice Address - Country:US
Practice Address - Phone:317-432-9401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01041417207Q00000X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000231048OtherANTHEM
IN080191954OtherRAILROAD MEDICARE
IN080191954OtherRAILROAD MEDICARE
IN827950I7Medicare PIN
IN000000231048OtherANTHEM
IN313600H8Medicare PIN