Provider Demographics
NPI:1801848320
Name:DEPASQUALE, STEPHEN ERNEST (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:ERNEST
Last Name:DEPASQUALE
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 1:102 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2136
Mailing Address - Country:US
Mailing Address - Phone:423-266-3636
Mailing Address - Fax:423-266-3633
Practice Address - Street 1:102 CENTRAL AVENUE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-1503
Practice Address - Country:US
Practice Address - Phone:423-266-3636
Practice Address - Fax:423-266-3633
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35113207VX0201X
GA50154207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000932071CMedicaid
TNG51126Medicare UPIN
TN3862929Medicare ID - Type Unspecified