Provider Demographics
NPI:1568691509
Name:CLEINMAN, ALYCIA (MD)
Entity Type:Individual
Prefix:
First Name:ALYCIA
Middle Name:
Last Name:CLEINMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1949 GUNBARREL RD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-3188
Mailing Address - Country:US
Mailing Address - Phone:423-495-3671
Mailing Address - Fax:423-495-4934
Practice Address - Street 1:725 GLENWOOD DR
Practice Address - Street 2:SUITE E786
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-1163
Practice Address - Country:US
Practice Address - Phone:423-682-8150
Practice Address - Fax:423-682-8151
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2017-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN55469207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS289089YR8UMedicare PIN
MS289089YR8UMedicare PIN
MS00089233Medicaid