Provider Demographics
NPI:1326022039
Name:DATTILO, JEFFERY BARTHOLOMEAU (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:BARTHOLOMEAU
Last Name:DATTILO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:410 42ND AVE N STE 400
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-3658
Mailing Address - Country:US
Mailing Address - Phone:615-329-7887
Mailing Address - Fax:615-346-6225
Practice Address - Street 1:4230 HARDING PIKE STE 705
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-2013
Practice Address - Country:US
Practice Address - Phone:615-385-1547
Practice Address - Fax:615-297-9161
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA2051772086S0129X
TN365242086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ007288Medicaid
TNQ007288Medicaid
103I777900Medicare PIN