MEDICARE: REETA MISRA 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	208000000X	Pediatrics Physician	MD14738	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

General Provider Information

NPI Number	:	1770578593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REETA MISRA MD

Provider Business Mailing Address
First Line	:	310 25TH AVE N
Second Line	:	SUITE 303
City	:	NASHVILLE
State	:	TN
Zip	:	37203-1515
Country	:	US
Telephone Number	:	615-333-1440
Fax Number	:	615-333-9639

Provider Business Practice Location Address
First Line	:	3443 DICKERSON PIKE
Second Line	:	STE 370
City	:	NASHVILLE
State	:	TN
Zip	:	37207-2519
Country	:	US
Telephone Number	:	615-865-5830
Fax Number	:	615-865-5831

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

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	07/08/2007

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Directions to “ REETA MISRA MD” Practice Location

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