Provider Demographics
NPI:1215981196
Name:TEDESCO, JAMES V (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:V
Last Name:TEDESCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5653 FRIST BLVD
Mailing Address - Street 2:SUITE 630
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-2094
Mailing Address - Country:US
Mailing Address - Phone:615-391-3971
Mailing Address - Fax:615-369-2032
Practice Address - Street 1:5653 FRIST BLVD
Practice Address - Street 2:SUITE 630
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-2094
Practice Address - Country:US
Practice Address - Phone:615-391-3971
Practice Address - Fax:615-369-2032
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2015-01-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN36266207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN110248369OtherR/R MEDICARE
TN4041640OtherTENNCARE
TN7016359OtherAETNA
TNH19000OtherHEALTHSPRING
TNP2007234OtherFIRST HEALTH
TN3875089Medicaid
TN4041640OtherBCBS
TN8714442OtherCIGNA
TNH19000Medicare UPIN
TN110248369OtherR/R MEDICARE