Provider Demographics
NPI:1538162359
Name:MARLOW, AMY L (MD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:L
Last Name:MARLOW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 632476
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-2476
Mailing Address - Country:US
Mailing Address - Phone:423-530-7970
Mailing Address - Fax:423-232-8581
Practice Address - Street 1:2002 BROOKSIDE DR STE 200
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4634
Practice Address - Country:US
Practice Address - Phone:423-530-7970
Practice Address - Fax:423-232-8581
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD38408208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3896750Medicaid
VA1538162359Medicaid
TN3896750Medicaid
TN3896750Medicare ID - Type Unspecified
0281780001Medicare PIN
TN103I086169Medicare UPIN
TN3896750Medicaid
I11786Medicare UPIN