Provider Demographics
NPI:1609052158
Name:JOHN W INTERLANDI
Entity Type:Organization
Organization Name:JOHN W INTERLANDI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:INTERLANDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-871-7258
Mailing Address - Street 1:5651 FRIST BLVD STE 208
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-2056
Mailing Address - Country:US
Mailing Address - Phone:615-871-7258
Mailing Address - Fax:615-871-4982
Practice Address - Street 1:5651 FRIST BLVD STE 208
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-2056
Practice Address - Country:US
Practice Address - Phone:615-871-7258
Practice Address - Fax:615-871-4982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12079207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B04240Medicare UPIN
TN3186316Medicare PIN