Basic Information
| Provider Information | |||||||||
| NPI: | 1821025784 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FINNEGAN | ||||||||
| FirstName: | MARTIN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 52690 | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379502690 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8657668800 | ||||||||
| FaxNumber: | 8654509374 | ||||||||
| Practice Location | |||||||||
| Address1: | 2333 MCCALLIE AVE | ||||||||
| Address2: | |||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374043258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234931387 | ||||||||
| FaxNumber: | 4235531224 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2006 | ||||||||
| LastUpdateDate: | 01/05/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 35202 | TN | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 000946382 | 05 | GA | MEDICAID | 300131268 | 01 | TN | RR MCARE-ADR | OTHER | 4022315 | 01 | TN | PLAZA BC/BS OF TN | OTHER | 009918735 | 05 | AL | MEDICAID | 4022310 | 01 | TN | ADR BC/BS OF TN | OTHER | 300131267 | 01 | TN | RR MCARE-CI | OTHER |