Provider Demographics
NPI:1295973683
Name:DIMITRI, ELIA CHARLES (MD)
Entity type:Individual
Prefix:DR
First Name:ELIA
Middle Name:CHARLES
Last Name:DIMITRI
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 1:320 OLD HICKORY BLVD APT 2819
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-1322
Mailing Address - Country:US
Mailing Address - Phone:615-662-6533
Mailing Address - Fax:
Practice Address - Street 1:320 OLD HICKORY BLVD APT 2819
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37221-1322
Practice Address - Country:US
Practice Address - Phone:615-662-6533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-23
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD4030208000000X
NC16995208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics