Provider Demographics
NPI:1316103310
Name:BRENTWOOD EAST PEDIATRICS
Entity type:Organization
Organization Name:BRENTWOOD EAST PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HARSHILA
Authorized Official - Middle Name:R
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-833-6411
Mailing Address - Street 1:626 BRENTWOOD EAST DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-6543
Mailing Address - Country:US
Mailing Address - Phone:615-833-6411
Mailing Address - Fax:615-832-0432
Practice Address - Street 1:626 BRENTWOOD EAST DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-6543
Practice Address - Country:US
Practice Address - Phone:615-833-6411
Practice Address - Fax:615-832-0432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-30
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD023854208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ002104Medicaid
TN3497120Medicaid