Provider Demographics
NPI:1134122732
Name:JASELSKIS, THOMAS P (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:P
Last Name:JASELSKIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 E BADDOUR PKWY
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-1703
Mailing Address - Country:US
Mailing Address - Phone:615-444-5325
Mailing Address - Fax:615-532-2785
Practice Address - Street 1:925 E BADDOUR PKWY
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-1703
Practice Address - Country:US
Practice Address - Phone:615-444-5325
Practice Address - Fax:615-532-2785
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000021081207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
4041604OtherBLUE CROSS BLUE SHIELD
TN2197543OtherAETNA
TN2197543OtherAETNA
TNE74905Medicare UPIN