Provider Demographics
NPI:1194139816
Name:MORIARTY, CHRISTOPHER RYAN (DO)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:RYAN
Last Name:MORIARTY
Suffix:
Gender:
Credentials:DO
Other - Prefix:DR
Other - First Name:CHRIS
Other - Middle Name:
Other - Last Name:MORIARTY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
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 16TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2207
Practice Address - Country:US
Practice Address - Phone:317-963-7070
Practice Address - Fax:317-329-2360
Is Sole Proprietor?:No
Enumeration Date:2014-06-20
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IN02006038A208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300039437Medicaid