Provider Demographics
NPI:1932195732
Name:IVAN, CRISTINA SIMONA (MD)
Entity type:Individual
Prefix:
First Name:CRISTINA
Middle Name:SIMONA
Last Name:IVAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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:317-963-2720
Mailing Address - Fax:
Practice Address - Street 1:1050 WISHARD BLVD
Practice Address - Street 2:RG 6TH FLOOR
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2872
Practice Address - Country:US
Practice Address - Phone:317-274-4455
Practice Address - Fax:317-278-4918
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2166192084N0400X
IN01065170A2084N0400X, 2084V0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA93367OtherFCHP
MA0035620OtherNHP
MA05-01246OtherEVERCARE
IN000000627778OtherANTHEM PTAN
IN200908480Medicaid
NH01Y008643MA01OtherANTHEM
MA2104873Medicaid
MAAA39276OtherHPHC
MA460281OtherTHP
MA3981555OtherAETNA
MAJ28937OtherBCBS
INP00761824OtherRAILROAD MEDICARE PTAN
MA0035620OtherNHP
MA05-01246OtherEVERCARE