Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | MD 23608 | TN |
NPI | 1194710467 |
---|---|
Provider Name | Mark D Hennessy |
First Address | Knoxville, TN 37920-1520 |
Second Address | Knoxville, TN 37920-1511 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2005 |
Last Update Date | 28/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3069396 | (05) | TN |
E51696 | (02) |