Basic Information
| Provider Information | |||||||||
| NPI: | 1295702991 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TESTERMAN | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | CHRIS | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 260 FORT SANDERS WEST BLVD | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379223355 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655584400 | ||||||||
| FaxNumber: | 8655584471 | ||||||||
| Practice Location | |||||||||
| Address1: | 1422 OLD WEISGARBER RD | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379092674 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655584400 | ||||||||
| FaxNumber: | 8655584471 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2006 | ||||||||
| LastUpdateDate: | 06/29/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0004X | 29290 | TN | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Foot and Ankle Surgery | 207X00000X | MD29290 | TN | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 200030630 | 01 | TN | RAILROAD MEDICARE | OTHER | 3818769 | 05 | TN | MEDICAID | TN0160 | 01 | TN | JOHN DEERE HEALTHCARE | OTHER | 3087106 | 01 | TN | BLUE CROSS BLUE SHIELD | OTHER | 1201443 | 01 | TN | UNITED HEALTH CARE | OTHER | 4457891 | 01 | TN | AETNA | OTHER | 100010640 | 01 | TN | TENNCARE | OTHER | TN0156 | 01 | TN | JOHN DEERE HEALTHCARE | OTHER |