MEDICARE: MARY K GINGRASS 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
1	208200000X	Plastic Surgery Physician	25024	TN

General Provider Information

NPI Number	:	1518959931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY K GINGRASS M.D.

Provider Business Mailing Address
First Line	:	1915 STATE ST
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37203-2209
Country	:	US
Telephone Number	:	615-467-6777
Fax Number	:	615-467-6778

Provider Business Practice Location Address
First Line	:	1915 STATE ST
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37203-2209
Country	:	US
Telephone Number	:	615-467-6777
Fax Number	:	615-467-6778

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	07/09/2007

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