Provider Demographics
NPI:1871817304
Name:TKACZYK, ERIC (MD, PHD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:TKACZYK
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3841 GREEN HILLS VILLAGE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-2691
Mailing Address - Country:US
Mailing Address - Phone:615-322-6485
Mailing Address - Fax:
Practice Address - Street 1:719 THOMPSON LN
Practice Address - Street 2:VANDERBILT DERMATOLOGY SUITE 26300
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204-3609
Practice Address - Country:US
Practice Address - Phone:615-322-6485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-26
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN54689207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology