Provider Demographics
NPI:1861590002
Name:MACCARONE, JAMES J (DO)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:J
Last Name:MACCARONE
Suffix:
Gender:M
Credentials:DO
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 3540
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-3540
Mailing Address - Country:US
Mailing Address - Phone:931-648-0202
Mailing Address - Fax:931-648-0252
Practice Address - Street 1:751 CHESAPEAKE LN
Practice Address - Street 2:SUITE 101
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-5263
Practice Address - Country:US
Practice Address - Phone:931-648-0202
Practice Address - Fax:931-648-0252
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO1235207R00000X
TN00000260208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN110204333OtherRAILROAD MEDICARE
TN3305160Medicaid
TN179292OtherANTHEM BC/BS
TN3144330OtherBLUE CROSS/BLUE SHIELD
TN3305160Medicaid
TN1780709451Medicare PIN