Provider Demographics
NPI:1942282090
Name:MARSIDI, PAUL JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JOSEPH
Last Name:MARSIDI
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:P.O. BOX 405827
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-5827
Mailing Address - Country:US
Mailing Address - Phone:870-934-5821
Mailing Address - Fax:870-934-5384
Practice Address - Street 1:1109 E REELFOOT AVE
Practice Address - Street 2:STE I
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-5856
Practice Address - Country:US
Practice Address - Phone:731-885-9393
Practice Address - Fax:731-885-9597
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13442208800000X
KY24254208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B04257Medicare UPIN
3186738Medicare ID - Type Unspecified
TNB04257Medicare UPIN