Healthcare Provider Details

I. General information

NPI: 1639155716
Provider Name (Legal Business Name): PETER DANIEL DONOFRIO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 03/26/2021
Certification Date: 03/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 TVC
NASHVILLE TN
37232
US

IV. Provider business mailing address

719 THOMPSON LN STE 30330
NASHVILLE TN
37204-4701
US

V. Phone/Fax

Practice location:
  • Phone: 615-322-3000
  • Fax:
Mailing address:
  • Phone: 615-322-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number29833
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number41292
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License Number41292
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: