Provider Demographics
NPI:1487621926
Name:BRZEZIENSKI, MARK A (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:BRZEZIENSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:979 E 3RD ST
Mailing Address - Street 2:SUITE C920
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2136
Mailing Address - Country:US
Mailing Address - Phone:423-756-7134
Mailing Address - Fax:423-763-4571
Practice Address - Street 1:979 E 3RD ST
Practice Address - Street 2:SUITE C920
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2136
Practice Address - Country:US
Practice Address - Phone:423-756-7134
Practice Address - Fax:423-763-4571
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN267872086S0105X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3010836OtherBCBS INSURANCE
TNTN0109OtherJOHN DEERE INSURANCE
GA000666487EMedicaid
TN00666487AMedicaid
GAP00004138OtherRAILROAD MEDICARE
TN2006636OtherBCBS GROUP
GAGA0103OtherJOHN DEERE INSURANCE
TN1114640001OtherPALMETTO DME
GA1300157OtherUHC INSURANCE
TN1348080OtherUHC INSURANCE
GA52577068004OtherBCBS INSURANCE
GA04051010007OtherPALMETTO DME
TN240004382OtherRAILROAD MEDICARE
TNPLF03906636OtherCHAMPUS INSURANCE
TN3010836OtherBCBS INSURANCE
GA04051010007OtherPALMETTO DME
TN3092478Medicare PIN