Provider Demographics
NPI:1851301303
Name:COLETTI, CYNTHIA M (MD)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:M
Last Name:COLETTI
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 1:1019 W OAKLAND AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2357
Mailing Address - Country:US
Mailing Address - Phone:423-915-5000
Mailing Address - Fax:423-915-5045
Practice Address - Street 1:1019 W OAKLAND AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-2357
Practice Address - Country:US
Practice Address - Phone:423-915-5000
Practice Address - Fax:423-915-5045
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD31852207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3846088 GRP 3706268Medicaid
TNTN01G5OtherJOHN DEERE
TNTN01M5OtherJOHN DEERE
TN3130635OtherBCBS
TN3846085 GRP3706267Medicaid
TN3846086 GRP 3709285Medicaid
TNTN0100OtherJOHN DEERE
TN3846089Medicare PIN
TN3846088Medicare PIN
TN3846085Medicare PIN
TNTN01M5OtherJOHN DEERE