Provider Demographics
NPI:1083683668
Name:CROMIE, MARC WILLIAM SR (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:WILLIAM
Last Name:CROMIE
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6734 LEE HWY
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2423
Mailing Address - Country:US
Mailing Address - Phone:423-899-0431
Mailing Address - Fax:423-499-9552
Practice Address - Street 1:6734 LEE HWY
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2423
Practice Address - Country:US
Practice Address - Phone:423-899-0431
Practice Address - Fax:423-499-9552
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD32158207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3851119Medicaid
H13570Medicare UPIN
TN3851111Medicare ID - Type Unspecified