Healthcare Provider Details

I. General information

NPI: 1235172164
Provider Name (Legal Business Name): ELIAS V HADDAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 05/12/2020
Certification Date: 05/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 21ST AVE S SUITE 5100
NASHVILLE TN
37232-0014
US

IV. Provider business mailing address

4230 HARDING PIKE STE 330
NASHVILLE TN
37205-2018
US

V. Phone/Fax

Practice location:
  • Phone: 615-322-2318
  • Fax: 615-875-6181
Mailing address:
  • Phone: 615-269-4545
  • Fax: 615-565-6748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number39630
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number39630
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number39630
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: