Healthcare Provider Details

I. General information

NPI: 1245202183
Provider Name (Legal Business Name): CLARISSA ANN MASHCHAK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: C. ANN MASHCHAK M.D.

II. Dates (important events)

Enumeration Date: 02/04/2006
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4884 SUNKIST TER
OOLTEWAH TN
37363-6851
US

IV. Provider business mailing address

4884 SUNKIST TER
OOLTEWAH TN
37363-6851
US

V. Phone/Fax

Practice location:
  • Phone: 423-774-8281
  • Fax:
Mailing address:
  • Phone: 423-774-8281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberMD0000018459
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMD0000018459
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: