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NPI Code Detail

MEDICARE: MARK D HENNESSY M.D.

MEDICARE: MARK D HENNESSY M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207VM0101XMaternal & Fetal Medicine PhysicianMD 23608TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1194710467
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK D HENNESSY M.D.
Provider Business Mailing Address
First Line : 1930 ALCOA HWY
Second Line : STE 435
City : KNOXVILLE
State : TN
Zip : 37920-1520
Country : US
Telephone Number : 865-305-8888
Fax Number : 865-305-7090
Provider Business Practice Location Address
First Line : 1924 ALCOA HWY
Second Line : SUITE 6-SOUTH
City : KNOXVILLE
State : TN
Zip : 37920-1511
Country : US
Telephone Number : 865-305-8888
Fax Number : 865-305-2514
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2005
Last Update Date : 10/28/2019

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