Provider Demographics
NPI:1770577538
Name:MERCHUN, GREGORY A (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:A
Last Name:MERCHUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9998 CROSSPOINT BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-3307
Mailing Address - Country:US
Mailing Address - Phone:317-579-2150
Mailing Address - Fax:317-579-2130
Practice Address - Street 1:9998 CROSSPOINT BLVD STE 200
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-3307
Practice Address - Country:US
Practice Address - Phone:317-579-2150
Practice Address - Fax:317-579-2130
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10415392085R0202X
IN01041539A2085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300059735OtherRAILROAD MEDICARE
P00033109OtherRR MEDICARE PIN
P00033111OtherRR MEDICARE PIN
P00033221OtherRR MEDICARE PIN
IN000000109954OtherANTHEM
P00033105OtherRR MEDICARE PIN
P00032760OtherRR MEDICARE PIN
P00032762OtherRR MEDICARE PIN
P00033108OtherRR MEDICARE PIN
P00032763OtherRR MEDICARE PIN
P00033110OtherRR MEDICARE PIN
P00033230OtherRR MEDICARE PIN
IN100320670AMedicaid
P00033112OtherRR MEDICARE PIN
P00033220OtherRR MEDICARE PIN
INC03496Medicare UPIN
P00032762OtherRR MEDICARE PIN
IN100320670AMedicaid
151700GGMedicare PIN
P00033105OtherRR MEDICARE PIN
P00032763OtherRR MEDICARE PIN