Provider Demographics
NPI:1649279811
Name:CARVER, MARK E (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:E
Last Name:CARVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 535744
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-5510
Mailing Address - Country:US
Mailing Address - Phone:844-294-5114
Mailing Address - Fax:865-691-0843
Practice Address - Street 1:135 W RAVINE RD
Practice Address - Street 2:SUITE 5-B
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3847
Practice Address - Country:US
Practice Address - Phone:423-224-3460
Practice Address - Fax:423-224-3465
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN21694207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
3042034OtherBS OF TN
281112OtherANTHEM BCBS
P050053051OtherRAILROAD MEDICARE
TN100010714Medicaid
TN3804029Medicaid
TN0100OtherJOHN DEERE
00013859OtherNHC CARE ADMIN.
VA005706271Medicaid
VA005706271Medicaid
TN3804029Medicare PIN
3042034OtherBS OF TN
P050053051OtherRAILROAD MEDICARE
VA005706271Medicaid