Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VE0102X | Reproductive Endocrinologist | MD0000018459 | TN |
Y | 207VG0400X | Gynecologist | MD0000018459 | TN |
NPI | 1245202183 |
---|---|
Provider Name | Dr. Clarissa Ann Mashchak |
First Address | Ooltewah, TN 37363-6681 |
Second Address | Ooltewah, TN 37363-6681 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2006 |
Last Update Date | 02/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3032078 | (05) | TN |
4270474 | BLUE CROSS BLUE SHIELD TN (01) | |
A44661 | (02) |