Provider Demographics
NPI:1245202183
Name:MASHCHAK, CLARISSA ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:CLARISSA
Middle Name:ANN
Last Name:MASHCHAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:C.
Other - Middle Name:ANN
Other - Last Name:MASHCHAK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6401 MOUNTAIN VIEW RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6681
Mailing Address - Country:US
Mailing Address - Phone:423-495-5890
Mailing Address - Fax:423-495-5899
Practice Address - Street 1:6401 MOUNTAIN VIEW RD
Practice Address - Street 2:SUITE 101
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-6681
Practice Address - Country:US
Practice Address - Phone:423-495-5890
Practice Address - Fax:423-495-5899
Is Sole Proprietor?:No
Enumeration Date:2006-02-04
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000018459207VE0102X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3032078Medicaid
4270474OtherBLUE CROSS BLUE SHIELD TN
TN103I169857Medicare PIN
TN3032078Medicaid