Provider Demographics
NPI:1386226991
Name:KETTERMAN, BRIAN THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:THOMAS
Last Name:KETTERMAN
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:VANDERBILT PEDIATRIC PRIMARY CARE CLINIC
Mailing Address - Street 2:2200 CHILDREN'S WAY, 8232 DOCTORS' OFFICE TOWER (DOT)
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37232-9225
Mailing Address - Country:US
Mailing Address - Phone:615-936-2555
Mailing Address - Fax:615-936-3601
Practice Address - Street 1:VANDERBILT PEDIATRIC PRIMARY CARE CLINIC
Practice Address - Street 2:2200 CHILDREN'S WAY, 8232 DOCTORS' OFFICE TOWER (DOT)
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-9225
Practice Address - Country:US
Practice Address - Phone:615-936-2555
Practice Address - Fax:615-936-3601
Is Sole Proprietor?:No
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program