Provider Demographics
NPI:1063738219
Name:BOSSHARDT, MARIBETH HAMRICK (MD)
Entity type:Individual
Prefix:
First Name:MARIBETH
Middle Name:HAMRICK
Last Name:BOSSHARDT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIBETH
Other - Middle Name:BANKS
Other - Last Name:HAMRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:P.O. BOX 440100
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37244
Mailing Address - Country:US
Mailing Address - Phone:615-329-0570
Mailing Address - Fax:615-329-0579
Practice Address - Street 1:605 GLENWOOD DR STE 200
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-1130
Practice Address - Country:US
Practice Address - Phone:423-698-1844
Practice Address - Fax:423-624-2226
Is Sole Proprietor?:No
Enumeration Date:2010-04-13
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36717207R00000X, 207RH0002X
390200000X
TN48458207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ033728Medicaid