Provider Demographics
NPI:1184739401
Name:SASLAWSKY, MARK JAY (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:JAY
Last Name:SASLAWSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:995 S YATES RD
Mailing Address - Street 2:STE. 1
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-0882
Mailing Address - Country:US
Mailing Address - Phone:901-527-7100
Mailing Address - Fax:901-527-7124
Practice Address - Street 1:995 S YATES RD
Practice Address - Street 2:STE. 1
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-0882
Practice Address - Country:US
Practice Address - Phone:901-527-7100
Practice Address - Fax:901-527-7124
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN019044208800000X
MS011984208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3033803Medicaid
TNP00420822OtherRR MEDICARE
TN0083556OtherBCBS
TNP00420822OtherRR MEDICARE
TN3033803Medicaid