Provider Demographics
NPI:1306943832
Name:VANDERPOOL, DAVID MARTIN (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MARTIN
Last Name:VANDERPOOL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5409 MARYLAND WAY
Mailing Address - Street 2:STE 119
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027
Mailing Address - Country:US
Mailing Address - Phone:615-833-3002
Mailing Address - Fax:615-221-1197
Practice Address - Street 1:5409 MARYLAND WAY
Practice Address - Street 2:STE 119
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027
Practice Address - Country:US
Practice Address - Phone:615-833-3002
Practice Address - Fax:615-221-1197
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000023744208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0492088OtherCIGNA
TN3003050OtherBCBST
TN0492088OtherCIGNA