Provider Demographics
NPI:1699844258
Name:DIGAETANO, DOLORES MARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:DOLORES
Middle Name:MARIA
Last Name:DIGAETANO
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 1:8316 MACON TER
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-8505
Mailing Address - Country:US
Mailing Address - Phone:901-757-0568
Mailing Address - Fax:901-754-8247
Practice Address - Street 1:8316 MACON TER
Practice Address - Street 2:SUITE 103
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-8505
Practice Address - Country:US
Practice Address - Phone:901-757-0568
Practice Address - Fax:901-754-8247
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD00000129072084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN60283OtherBCBS OF TN
TN3387193Medicaid
MS03375701Medicaid
MS03375701Medicaid
B04332Medicare UPIN
TN3188434Medicare ID - Type Unspecified
MS260000174Medicare ID - Type Unspecified
TN260018811Medicare ID - Type UnspecifiedRAILROAD MEDICARE