Provider Demographics
NPI:1104802198
Name:STAUBER, MARY CHRISTINA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:CHRISTINA
Last Name:STAUBER
Suffix:
Gender:F
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:988 OAK RIDGE TPKE
Mailing Address - Street 2:PHYSICIANS PLAZA, STE 350
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-6930
Mailing Address - Country:US
Mailing Address - Phone:865-483-7030
Mailing Address - Fax:865-483-3954
Practice Address - Street 1:988 OAK RIDGE TPKE
Practice Address - Street 2:PHYSICIANS PLAZA, STE 350
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6930
Practice Address - Country:US
Practice Address - Phone:865-483-7030
Practice Address - Fax:865-483-3954
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNPA0326363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3666158Medicare ID - Type Unspecified
TNR70550Medicare UPIN