Individual
CHARLES J. MASCIOLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
990 OAK RIDGE TPKE, OAK RIDGE, TN 37830-6976
(865) 835-1000
(865) 539-8008
Mailing address
PO BOX 635134, CINCINNATI, OH 45263-0001
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
MD40673
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3813856
—
TN
01
—
4125948
BLUE CROSS
TN
01
—
P00319878
RAILROAD MEDICARE
TN
Enumeration date
06/20/2006
Last updated
11/15/2007
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