Healthcare Provider Details

I. General information

NPI: 1912108598
Provider Name (Legal Business Name): ANDREW PACE LARAMORE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 06/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 GLENWOOD DR SUITE E-888
CHATTANOOGA TN
37404-1163
US

IV. Provider business mailing address

725 GLENWOOD DR SUITE E-888
CHATTANOOGA TN
37404-1163
US

V. Phone/Fax

Practice location:
  • Phone: 423-629-7688
  • Fax: 423-495-6175
Mailing address:
  • Phone: 423-629-7688
  • Fax: 423-495-6175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number140940
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD0000049572
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License NumberMD0000049572
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: