Provider Demographics
NPI:1730535121
Name:KOSTANDY, ALISON Q (MD)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:Q
Last Name:KOSTANDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PHUONG THAO
Other - Middle Name:TRAN
Other - Last Name:QUAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:355 W 15TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202
Practice Address - Country:US
Practice Address - Phone:317-948-7450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-04
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01088115A2084E0001X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084E0001XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyEpilepsy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300064368Medicaid
IN1730535121OtherANTHEM PTAN
INQ00487532OtherRAILROAD PTAN
IN1102690175OtherANTHEM PTAN
IN262210072OtherMEDICARE PTAN