Healthcare Provider Details

I. General information

NPI: 1801848320
Provider Name (Legal Business Name): STEPHEN ERNEST DEPASQUALE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 06/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 CENTRAL AVENUE
CHATTANOOGA TN
37403-1503
US

IV. Provider business mailing address

102 CENTRAL AVE
CHATTANOOGA TN
37403-2136
US

V. Phone/Fax

Practice location:
  • Phone: 423-266-3636
  • Fax: 423-266-3633
Mailing address:
  • Phone: 423-266-3636
  • Fax: 423-266-3633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number35113
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number50154
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: