MEDICARE: DR. ROBERT LEE NEADERTHAL M.D.

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	174400000X	Specialist	MD08275	TN

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	3011452	OTHER	TN	BLUE CROSS BLUE SHIELD
3	0440482	OTHER	TN	UNITED HEALTHCARE

General Provider Information

NPI Number	:	1417950965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT LEE NEADERTHAL M.D.

Provider Business Mailing Address
First Line	:	3919 CROSS CREEK RD
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37215-2428
Country	:	US
Telephone Number	:	615-584-8422
Fax Number	:

Provider Business Practice Location Address
First Line	:	3919 CROSS CREEK RD
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37215-2428
Country	:	US
Telephone Number	:	615-584-8422
Fax Number	:

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

Provider Enumeration Date	:	05/28/2005
Last Update Date	:	12/13/2013

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