Provider Demographics
NPI:1881642791
Name:MARASCO, CHRIS M (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:M
Last Name:MARASCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:112 AIRPORT DRIVE
Mailing Address - Street 2:SUITE H
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37160
Mailing Address - Country:US
Mailing Address - Phone:931-680-6360
Mailing Address - Fax:931-680-9909
Practice Address - Street 1:112 AIRPORT DRIVE
Practice Address - Street 2:SUITE H
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160
Practice Address - Country:US
Practice Address - Phone:931-680-6360
Practice Address - Fax:931-680-9909
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG46383207R00000X
TN45678207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC36094Medicare UPIN
CAWG46383HMedicare ID - Type UnspecifiedMEDICARE PPIN NUMBER