Dalle-Ave, Mark Joseph

Dalle-Ave, Mark Joseph is an individual health care provider with primary practice located at 4307 Highway 66 S , Rogersville TN 37857-3155. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Dalle-Ave, Mark Joseph can be contacted via phone (423) 921-1600.

Contact Information

Primary practice address
4307 Highway 66 S Rogersville TN 37857-3155
Phone: (423) 921-1600
Fax: (423) 921-1677
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 25875 Tennessee

Profile Details

NPI number 1801892054
LBN Legal business name Dalle-Ave, Mark Joseph
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 22nd, 2005
Last updated Feb 28th, 2014 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1801892054 NPPES
Tennessee Other 4057107 BCBST
Tennessee MEDICAID 3085703 BCBST

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