Provider Demographics
NPI:1801849674
Name:EMERY, MARK W (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:W
Last Name:EMERY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 W STONE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-6027
Mailing Address - Country:US
Mailing Address - Phone:423-247-5197
Mailing Address - Fax:423-247-5254
Practice Address - Street 1:111 W STONE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-6027
Practice Address - Country:US
Practice Address - Phone:423-247-5197
Practice Address - Fax:423-247-5254
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN19732207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0094319OtherBLUE CROSS BLUE SHIELD
KY65906208Medicaid
VA065196OtherANTHEM
TN100023382OtherPHP TENN CARE
TN1000908Medicaid
TN62134825601OtherJOHN DEERE HEALTHCARE
TNZ101OtherUNITED HEALTHCARE OF THE RIVER VALLEY
VA006040209OtherVIRGINIA MEDICAID
TN3047487Medicaid
TN1736855OtherUNITED HEALTHCARE
TN5141032OtherAETNA
KY64798580OtherKENTUCKY MEDICAID
TN1736855OtherUNITED HEALTHCARE
TN62134825601OtherJOHN DEERE HEALTHCARE
VAV V3878BMedicare PIN
GA290014077Medicare PIN
TN103I292940Medicare PIN
TN100023382OtherPHP TENN CARE
TN0094319OtherBLUE CROSS BLUE SHIELD
E61100Medicare UPIN
VAV V3878AMedicare PIN
GAP00195517Medicare PIN
TN3700107Medicare PIN
TN3287305Medicare PIN