Provider Demographics
NPI:1851387369
Name:EBENEZER, ALBERT CS (MD)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:CS
Last Name:EBENEZER
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:PO BOX 59076
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37950-9076
Mailing Address - Country:US
Mailing Address - Phone:865-588-1847
Mailing Address - Fax:865-588-7390
Practice Address - Street 1:1451 DOWELL SPRINGS BLVD
Practice Address - Street 2:STE 201
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909
Practice Address - Country:US
Practice Address - Phone:865-588-1847
Practice Address - Fax:865-588-7390
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD7866207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3708778Medicaid
3708778Medicare ID - Type Unspecified
TN3708778Medicaid