Provider Demographics
NPI: | 1972594638 |
---|---|
Name: | VACHON, CLAUDE A (MD) |
Entity type: | Individual |
Prefix: | |
First Name: | CLAUDE |
Middle Name: | A |
Last Name: | VACHON |
Suffix: | |
Gender: | |
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: | 110 29TH AVE N |
Mailing Address - Street 2: | STE 202 |
Mailing Address - City: | NASHVILLE |
Mailing Address - State: | TN |
Mailing Address - Zip Code: | 37203-1401 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 110 29TH AVE N |
Practice Address - Street 2: | STE 202 |
Practice Address - City: | NASHVILLE |
Practice Address - State: | TN |
Practice Address - Zip Code: | 37203-1401 |
Practice Address - Country: | US |
Practice Address - Phone: | 615-327-4304 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-11-02 |
Last Update Date: | 2025-04-13 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TN | MD40583 | 174400000X |
ND | PT20723 | 207L00000X |
TN | 40583 | 207L00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | |
No | 174400000X | Other Service Providers | Specialist |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TN | 4119018 | Other | BCBS |
AL | 009933512 | Medicaid | |
TN | 3335723 | Medicaid | |
AL | 009933512 | Medicaid | |
TN | P00285975 | Medicare PIN | |
TN | 3335723 | Medicare PIN |