Provider Demographics
NPI:1508836842
Name:BROTHERTON, DEANA R (MD)
Entity Type:Individual
Prefix:DR
First Name:DEANA
Middle Name:R
Last Name:BROTHERTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:653 MERCHANTS GREENE BLVD.
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37813
Mailing Address - Country:US
Mailing Address - Phone:423-492-6700
Mailing Address - Fax:865-374-2131
Practice Address - Street 1:653 MERCHANTS GREENE BLVD.
Practice Address - Street 2:SUITE 201
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813
Practice Address - Country:US
Practice Address - Phone:423-492-6700
Practice Address - Fax:865-374-2131
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD30887207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3144182OtherBLUECARE-BOGARD
TN100028814OtherPHP
TN3144180OtherBCBST
TN3144181OtherBCBST
TN3142811OtherBCBST
TN3846342Medicaid
TN3144180OtherBCBST
TN3144181OtherBCBST
TNG97576Medicare UPIN
3846345Medicare PIN
3846344Medicare PIN