Provider Demographics
NPI:1700889888
Name:WASSYNGER, WILLIAM WALTER (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:WALTER
Last Name:WASSYNGER
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 1:228 W 4TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-2489
Mailing Address - Country:US
Mailing Address - Phone:931-783-5582
Mailing Address - Fax:931-526-6760
Practice Address - Street 1:228 W 4TH ST STE 200
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2489
Practice Address - Country:US
Practice Address - Phone:931-372-0405
Practice Address - Fax:931-372-0463
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP580207RC0001X, 207RC0000X
TN37302207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3881608Medicaid
TN6011815OtherBLUE CROSS-BLUE SHIELD
TNP00669730OtherRR MEDICARE
TN1510044Medicaid
TNE90750Medicare UPIN
TNP00669730OtherRR MEDICARE
TN1510044Medicaid