Provider Demographics
NPI:1376533489
Name:MADHOK, ASHISH B (MD)
Entity Type:Individual
Prefix:DR
First Name:ASHISH
Middle Name:B
Last Name:MADHOK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2312 KNOB CREEK RD
Mailing Address - Street 2:SUITE208
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2367
Mailing Address - Country:US
Mailing Address - Phone:423-610-1099
Mailing Address - Fax:423-610-1166
Practice Address - Street 1:2312 KNOB CREEK RD
Practice Address - Street 2:SUITE208
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-2367
Practice Address - Country:US
Practice Address - Phone:423-610-1099
Practice Address - Fax:423-610-1166
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN398742080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN02547560Medicaid
TNH97077Medicare UPIN