Provider Demographics
NPI:1760425300
Name:BRUNETTO, ANGELINE D (MD)
Entity Type:Individual
Prefix:
First Name:ANGELINE
Middle Name:D
Last Name:BRUNETTO
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:PO BOX 634706
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-0001
Mailing Address - Country:US
Mailing Address - Phone:865-292-3000
Mailing Address - Fax:
Practice Address - Street 1:200 STONECREST BLVD
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-6810
Practice Address - Country:US
Practice Address - Phone:615-768-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN28786207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3815217Medicaid
TNP00232365OtherRAILROAD MEDICARE
TN3070530OtherBLUECROSS
TN3126223OtherBLUECROSS
TN3815216Medicaid
TN3815216Medicare PIN
TN3126223OtherBLUECROSS
TNP00232365OtherRAILROAD MEDICARE