MEDICARE: DAVID W. MARDEN DO

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	207V00000X	Obstetrics & Gynecology Physician	DO 1214	TN

Other Identifiers

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

General Provider Information

NPI Number	:	1699778605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID W. MARDEN DO

Provider Business Mailing Address
First Line	:	1 MEDICAL PARK BLVD STE 305E
Second Line	:
City	:	BRISTOL
State	:	TN
Zip	:	37620-7450
Country	:	US
Telephone Number	:	423-844-5640
Fax Number	:	423-844-5645

Provider Business Practice Location Address
First Line	:	1 MEDICAL PARK BLVD STE 305E
Second Line	:
City	:	BRISTOL
State	:	TN
Zip	:	37620-7450
Country	:	US
Telephone Number	:	423-844-5640
Fax Number	:	423-844-5645

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	11/30/2016

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Directions to “ DAVID W. MARDEN DO” Practice Location

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