Provider Demographics
NPI:1649596156
Name:CHRIS MARASCO M.D., PC
Entity type:Organization
Organization Name:CHRIS MARASCO M.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:MARASCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-680-6360
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-09
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN45678207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty