Provider Demographics
NPI:1699856567
Name:GITSCHLAG, GARY NORMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:NORMAN
Last Name:GITSCHLAG
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 1:2100 W CLINCH AVE
Mailing Address - Street 2:SUITE 400 KOPPEL PLAZA
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-2219
Mailing Address - Country:US
Mailing Address - Phone:865-521-7998
Mailing Address - Fax:865-521-7405
Practice Address - Street 1:2100 W CLINCH AVE
Practice Address - Street 2:SUITE 400 KOPPEL PLAZA
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-2219
Practice Address - Country:US
Practice Address - Phone:865-521-7998
Practice Address - Fax:865-521-7405
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000014247207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN20250OtherBLUE CROSS PROVIDER #
TN3196142Medicaid
KY64772437Medicaid
KY64772437Medicaid
TNB04698Medicare UPIN