Provider Demographics
NPI:1699193730
Name:TSAROVA, KATSIARYNA SERGEEVNA (MD)
Entity type:Individual
Prefix:
First Name:KATSIARYNA
Middle Name:SERGEEVNA
Last Name:TSAROVA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:
Other - Last Name:TSAROVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
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 1:1111 RONALD REAGAN PKWY
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-7085
Practice Address - Country:US
Practice Address - Phone:317-217-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-05
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11709336-1205207R00000X
IN01078733A207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN183380149OtherMEDICARE PTAN
IN000001558214OtherANTHEM PTAN
IN1102493263OtherANTHEM PTAN
IN264910298OtherMEDICARE PTAN
INQ00170701OtherRAILROAD PTAN
INQ00488569OtherRAILROAD PTAN
IN000001557956OtherANTHEM PTAN
IN300005240Medicaid