Provider Demographics
NPI:1346248556
Name:MILITANA, GARY ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:ANTHONY
Last Name:MILITANA
Suffix:
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 1:1320 OLD WEISGARBER RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-1291
Mailing Address - Country:US
Mailing Address - Phone:865-694-6919
Mailing Address - Fax:865-694-4339
Practice Address - Street 1:401 SEWELL DR
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:TN
Practice Address - Zip Code:38583-1223
Practice Address - Country:US
Practice Address - Phone:931-738-4173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN153292085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3051089Medicaid
TNC74855Medicare UPIN
TN3051089Medicare ID - Type Unspecified