Maryann L Bridge, M.D.

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

01036097A Issued in IN

Practice address

2400 17TH St
Columbus, IN 47201-5351

Phone

(812) 376-5144

Fax

(812) 376-5431

NPI assigned

Oct 13, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Columbus Indiana Clinical Pathology, LLC

  • Anatomic Pathology & Clinical Pathology Physician
  • Columbus, IN
  • NPI 1902138837
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671580800000",
    "number": "1962592980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1329",
            "city": "COLUMBUS",
            "state": "IN",
            "postal_code": "472021329",
            "telephone_number": "812-418-0014",
            "fax_number": "812-418-0076"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 17TH ST",
            "city": "COLUMBUS",
            "state": "IN",
            "postal_code": "472015351",
            "telephone_number": "812-376-5144",
            "fax_number": "812-376-5431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRIDGE",
        "first_name": "MARYANN",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-13",
        "last_updated": "2022-12-21",
        "certification_date": "2022-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "IN",
            "license": "01036097A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200008140A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katelin Breaux
• Kaden Brewer, RBT
• Terri Ann Brewer, MSW, LCSW, ACSW
• Megan Brewster, RBT
• Dennis Michael Brich, DDS
• Ashlan Briles
• Sarah Bringman, NP
• Roger Brinkman, LCSW
• Dorajo Brittain, RBT
• Taylor Brittain

• Anatomic Pathology & Clinical Pathology Physician in Columbus, IN
• Providers in Columbus, IN by specialty
• Anatomic Pathology & Clinical Pathology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.