Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | MD029206 | TN |
NPI | 1073516340 |
---|---|
Provider Name | Dr. Mark Tedder |
First Address | Nashville, TN 37228-1317 |
Second Address | Nashville, TN 37205-2013 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2005 |
Last Update Date | 16/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01616927 | AMERIGROUP (01) | TN |
0995624 | AETNA HMO (01) | TN |
1840022 | UNITED HEALTHCARE (01) | TN |
3812958 | (05) | TN |
4334022 | BCBST (01) | TN |
5463506 | AETNA PPO (01) | TN |
8773249003 | CIGNA PPO (01) | TN |
8773249004 | CIGNA HMO (01) | TN |
G54788 | (02) | TN |
P01004440 | RR MEDICARE (01) | TN |