Provider Demographics
NPI:1386683290
Name:D'ADDARIO, STEPHEN F (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:F
Last Name:D'ADDARIO
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 1:3810 CENTRAL PIKE
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-3494
Mailing Address - Country:US
Mailing Address - Phone:815-744-8554
Mailing Address - Fax:
Practice Address - Street 1:190D SAUNDERSVILLE RD STE 2005
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-1008
Practice Address - Country:US
Practice Address - Phone:629-240-8588
Practice Address - Fax:615-851-7760
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35090328207ND0101X
OH35.090328207ND0101X
ARE-6763207ND0101X
TN6544207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2780629Medicaid
OH2780629Medicaid
4217051Medicare PIN
AR4P788Medicare PIN