Provider Demographics
NPI:1760493860
Name:CRAMOLINI, GORDON MARK (MD)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:MARK
Last Name:CRAMOLINI
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:PO BOX 15010
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37901-5010
Mailing Address - Country:US
Mailing Address - Phone:865-541-8485
Mailing Address - Fax:865-541-8727
Practice Address - Street 1:2018 CLINCH AVENUE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-2301
Practice Address - Country:US
Practice Address - Phone:865-541-8485
Practice Address - Fax:865-541-8727
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN28168207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3038640OtherBLUECARE
TN3038640OtherTENNCARE SELECT
TN3803801Medicaid
TN3038640OtherBLUE CROSS BLUE SHIELD
KY64925308Medicaid
TN3038640OtherTENNCARE SELECT