Provider Demographics
NPI:1093760787
Name:BORN, MARK LEONARD (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:LEONARD
Last Name:BORN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:432 PRESTWICK CT
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-5016
Mailing Address - Country:US
Mailing Address - Phone:615-873-7550
Mailing Address - Fax:615-873-8431
Practice Address - Street 1:1310 24TH AVE S
Practice Address - Street 2:TENNESSEE VALLEY HEALTH SYSTEM
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-2637
Practice Address - Country:US
Practice Address - Phone:615-873-7550
Practice Address - Fax:615-873-8431
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD0110342085R0202X, 207UN0902X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207UN0902XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Imaging & Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3023997OtherMEDICARE MEDICAID/TENNCARE
TN3023997Medicaid
TNA98794Medicare UPIN