Provider Demographics
NPI:1043535107
Name:DR MARK STEVEN JOSOVITZ, MD
Entity Type:Organization
Organization Name:DR MARK STEVEN JOSOVITZ, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:JOSOVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-893-7786
Mailing Address - Street 1:726 S CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-4926
Mailing Address - Country:US
Mailing Address - Phone:615-893-7786
Mailing Address - Fax:615-225-2046
Practice Address - Street 1:726 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-4926
Practice Address - Country:US
Practice Address - Phone:615-893-7786
Practice Address - Fax:615-225-2046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18433174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3822765Medicaid
TN3822765Medicaid