Provider Demographics
NPI:1760461560
Name:PASIPANODYA, ALPHONSE (MD)
Entity Type:Individual
Prefix:DR
First Name:ALPHONSE
Middle Name:
Last Name:PASIPANODYA
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 1:1005 DR. D. B. TODD BLVD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37208
Mailing Address - Country:US
Mailing Address - Phone:615-327-6342
Mailing Address - Fax:615-327-5579
Practice Address - Street 1:1005 DR. D. B. TODD BLVD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37208
Practice Address - Country:US
Practice Address - Phone:615-327-6342
Practice Address - Fax:615-327-5579
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10137208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3170007Medicare ID - Type Unspecified
TN3170009Medicare ID - Type Unspecified
TNB03382Medicare UPIN