1619954781 NPI number — DR. GARY B VERNA PH.D.

Table of content: DR. GARY B VERNA PH.D. (NPI 1619954781)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619954781 NPI number — DR. GARY B VERNA PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VERNA
Provider First Name:
GARY
Provider Middle Name:
B
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619954781
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4818
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAK RIDGE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37831-4818
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-712-0234
Provider Business Mailing Address Fax Number:
423-562-6106

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 W BEECH ST
Provider Second Line Business Practice Location Address:
RM 1
Provider Business Practice Location Address City Name:
LA FOLLETTE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37766-3516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-712-0234
Provider Business Practice Location Address Fax Number:
423-562-6106
Provider Enumeration Date:
12/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  P0000001449 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 352427000 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: TN0101 . This is a "JOHNDEERE HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 352427000 . This is a "MAGELLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4039056 . This is a "BLUECROSS BLUESHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 702009618 . This is a "CARITEN HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 36835521 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3683555 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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