Provider Demographics
NPI:1578501904
Name:TESAURO, THOMAS A (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:A
Last Name:TESAURO
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 1:2300 PATTERSON ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1538
Mailing Address - Country:US
Mailing Address - Phone:615-342-6828
Mailing Address - Fax:615-342-6836
Practice Address - Street 1:2300 PATTERSON ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1538
Practice Address - Country:US
Practice Address - Phone:615-342-6828
Practice Address - Fax:615-342-6836
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27156207RC0000X, 207RH0002X, 207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3826562Medicaid
TN4141663OtherBLUE CROSS
P00394317OtherRAIDROAD MEDICARE
5730652OtherAETNA
KY6471248200OtherKENTUCKY MEDICAID
3826560OtherMEDICARE
TN6011197OtherBLUE CROSS-BLUE SHIELD
TN3097898OtherBCBS
TN3826562Medicaid
TN103I115795Medicare PIN
KY6471248200OtherKENTUCKY MEDICAID