Provider Demographics
NPI:1972687309
Name:MARK, DEBORAH WEN-YEE (MD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:WEN-YEE
Last Name:MARK
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:310 25TH AVENUE NORTH
Mailing Address - Street 2:CENTENNIAL PEDIATRICS PC SUITE 201
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203
Mailing Address - Country:US
Mailing Address - Phone:615-620-5154
Mailing Address - Fax:615-321-5205
Practice Address - Street 1:115 WINWOOD DRIVE
Practice Address - Street 2:CENTENNIAL PEDIATRICS STE 105
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087
Practice Address - Country:US
Practice Address - Phone:615-453-1930
Practice Address - Fax:615-453-1848
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2008-03-03
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Provider Licenses
StateLicense IDTaxonomies
NJMA68658208000000X
TN42798208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1501011Medicaid
TNH24774Medicare UPIN
TN1501011Medicaid