Provider Demographics
NPI:1760563613
Name:SIMEONE, ALAN A (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:A
Last Name:SIMEONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2501 CITICO AVE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-1127
Mailing Address - Country:US
Mailing Address - Phone:423-697-2000
Mailing Address - Fax:423-697-2118
Practice Address - Street 1:2525 DESALES AVE STE F1009
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-1161
Practice Address - Country:US
Practice Address - Phone:423-697-2000
Practice Address - Fax:423-697-2118
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD000477352086S0102X, 2086S0127X, 208G00000X
OH35 126676208G00000X
GA56485208G00000X
TN59222208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05078049Medicaid
WA8491128Medicaid
WA8491128Medicaid
H57403Medicare UPIN
MS292321YR8UMedicare PIN