Provider Demographics
NPI:1588641138
Name:VALLEY, MARC A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:A
Last Name:VALLEY
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 1:928 W. OAKLAND
Mailing Address - Street 2:SUITE 222
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604
Mailing Address - Country:US
Mailing Address - Phone:423-282-3379
Mailing Address - Fax:
Practice Address - Street 1:926 W OAKLAND AVE
Practice Address - Street 2:222
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-1445
Practice Address - Country:US
Practice Address - Phone:423-282-3379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38667207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1588641138OtherNPI
TNMD38867OtherLICENSE
TNBV488760OtherDEA
VA1588641138Medicaid
TN452687190OtherTAX ID
NC5909071Medicaid
E93002Medicare UPIN
TN1514405Medicaid
TN4166771OtherBCBS
TN30000841Medicare PIN