Provider Demographics
NPI:1790766590
Name:MACQUARRIE, MICHAEL A (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:MACQUARRIE
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 1:602 E CLARK BLVD
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-2121
Mailing Address - Country:US
Mailing Address - Phone:615-494-3202
Mailing Address - Fax:615-494-5206
Practice Address - Street 1:602 E CLARK BLVD
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-2121
Practice Address - Country:US
Practice Address - Phone:615-494-3202
Practice Address - Fax:931-680-9835
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000026300208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4030468OtherBCBS
TN3089643Medicaid
G01281Medicare UPIN
TN3089643Medicaid