Provider Demographics
NPI:1861452138
Name:MCELANEY, MARY AGNES (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:AGNES
Last Name:MCELANEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:397 WALLACE RD
Mailing Address - Street 2:SUITE 415
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-4854
Mailing Address - Country:US
Mailing Address - Phone:615-834-9781
Mailing Address - Fax:615-834-0864
Practice Address - Street 1:397 WALLACE RD
Practice Address - Street 2:SUITE 415
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-4854
Practice Address - Country:US
Practice Address - Phone:615-834-9781
Practice Address - Fax:615-834-0864
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD018986207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNA99763Medicare UPIN
TN3703599Medicare ID - Type Unspecified