1659340610 NPI number — DR. MAREK M PIENKOWSKI M.D., PH.D.

Table of content: DR. MAREK M PIENKOWSKI M.D., PH.D. (NPI 1659340610)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659340610 NPI number — DR. MAREK M PIENKOWSKI M.D., PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PIENKOWSKI
Provider First Name:
MAREK
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D., 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:
1659340610
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7417 KINGSTON PIKE
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37919-5606
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-584-4112
Provider Business Mailing Address Fax Number:
865-588-5140

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7417 KINGSTON PIKE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37919-5606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-584-4112
Provider Business Practice Location Address Fax Number:
865-588-5140
Provider Enumeration Date:
03/14/2006

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: 207KA0200X , with the licence number:  MD15320 , 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: 0202905 . This is a "BCBSTN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 059803 . This is a "BCBSVA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 0030601 . This is a "BCBSTN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3006456 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 067080 . This is a "BCBSVA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 3006457 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0056936 . This is a "BCBSTN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 0166234 . This is a "BCBSTN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 064686 . This is a "BCBSVA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 3006458 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30065459 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2004413 . This is a "BCBSTN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3006450 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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