MEDICARE: VINEET MISHRA 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	207NS0135X	Procedural Dermatology Physician	61314	TN
2	207NS0135X	Procedural Dermatology Physician	A120997	CA
3	207ND0101X	MOHS-Micrographic Surgery Physician	A120997	CA
4	207N00000X	Dermatology Physician	A120997	CA
5	207N00000X	Dermatology Physician	61314	TN
6	207ND0101X	MOHS-Micrographic Surgery Physician	61314	TN

General Provider Information

NPI Number	:	1639337181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINEET MISHRA MD

Provider Business Mailing Address
First Line	:	3803 BEDFORD AVE STE 102
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37215-2565
Country	:	US
Telephone Number	:	615-249-4700
Fax Number	:

Provider Business Practice Location Address
First Line	:	3803 BEDFORD AVE STE 102
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37215-2565
Country	:	US
Telephone Number	:	615-813-0145
Fax Number	:

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

Provider Enumeration Date	:	05/30/2008
Last Update Date	:	10/04/2024

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