Healthcare Provider Details

I. General information

NPI: 1811072689
Provider Name (Legal Business Name): CHATTANOOGAS PROGRAM IN WOMENS ONCOLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 11/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 CENTRAL AVE
CHATTANOOGA TN
37403-1503
US

IV. Provider business mailing address

102 CENTRAL AVE
CHATTANOOGA TN
37403-1503
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

VIII. Authorized Official

Name: DR. STEPHEN E. DEPASQUALE
Title or Position: PHYSICIAN
Credential: MD
Phone: 423-266-3636