Provider Demographics
NPI:1255368767
Name:STANKEWICZ, MARK ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANTHONY
Last Name:STANKEWICZ
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Gender:M
Credentials:MD
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Mailing Address - Street 1:4230 HARDING PIKE
Mailing Address - Street 2:SUITE 330
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-2013
Mailing Address - Country:US
Mailing Address - Phone:615-269-4545
Mailing Address - Fax:615-565-6789
Practice Address - Street 1:4230 HARDING PIKE
Practice Address - Street 2:SUITE 330
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-2013
Practice Address - Country:US
Practice Address - Phone:615-269-4545
Practice Address - Fax:615-565-6789
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2008-07-25
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Provider Licenses
StateLicense IDTaxonomies
TNMD34754207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN30619701Medicare PIN
I25018Medicare UPIN