Provider Demographics
NPI:1639337181
Name:MISHRA, VINEET (MD)
Entity Type:Individual
Prefix:
First Name:VINEET
Middle Name:
Last Name:MISHRA
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 1:3803 BEDFORD AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-2565
Mailing Address - Country:US
Mailing Address - Phone:615-249-4700
Mailing Address - Fax:
Practice Address - Street 1:3803 BEDFORD AVE STE 102
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-2565
Practice Address - Country:US
Practice Address - Phone:615-813-0145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA120997207N00000X, 207NS0135X, 207ND0101X
TN61314207N00000X, 207ND0101X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX326500101Medicaid
TX326500102OtherCSHCN
TX326500101Medicaid