MEDICARE: ELIAS V HADDAD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	39630	TN
2	207RI0011X	Interventional Cardiology Physician	39630	TN
3	207RC0000X	Cardiovascular Disease Physician	39630	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P00395861	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	7121802	OTHER		AETNA
4	4141588	OTHER	TN	BLUE CROSS
6	4119774	OTHER	TN	BCBS

General Provider Information

NPI Number	:	1235172164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIAS V HADDAD MD

Provider Business Mailing Address
First Line	:	4230 HARDING PIKE
Second Line	:	STE 330
City	:	NASHVILLE
State	:	TN
Zip	:	37205-2018
Country	:	US
Telephone Number	:	615-269-4545
Fax Number	:	615-565-6748

Provider Business Practice Location Address
First Line	:	1215 21ST AVE S
Second Line	:	SUITE 5100
City	:	NASHVILLE
State	:	TN
Zip	:	37232-0014
Country	:	US
Telephone Number	:	615-322-2318
Fax Number	:	615-875-6181

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	05/12/2020

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