Provider Demographics
NPI:1962381376
Name:BROAD RIPPLE PEDIATRICS
Entity type:Organization
Organization Name:BROAD RIPPLE PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:HALBERSTADT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:317-875-0009
Mailing Address - Street 1:6527 CARROLLTON AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-1664
Mailing Address - Country:US
Mailing Address - Phone:317-875-0009
Mailing Address - Fax:317-875-3993
Practice Address - Street 1:6527 CARROLLTON AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-1664
Practice Address - Country:US
Practice Address - Phone:317-875-0009
Practice Address - Fax:317-875-3993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-29
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty