Provider Demographics
NPI:1144222035
Name:BARTHOLOMEW, KENNETH EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:EDWARD
Last Name:BARTHOLOMEW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170-D EAST MAIN STREET
Mailing Address - Street 2:PMB 115
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-2579
Mailing Address - Country:US
Mailing Address - Phone:615-860-3500
Mailing Address - Fax:615-860-2420
Practice Address - Street 1:3443 DICKERSON PIKE
Practice Address - Street 2:SUITE 590
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37207-2519
Practice Address - Country:US
Practice Address - Phone:615-860-3500
Practice Address - Fax:615-860-2420
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000015080207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3377000Medicaid
TN3003280Medicare ID - Type Unspecified
TN3377000Medicaid