Provider Demographics
NPI:1669482295
Name:BALATICO, ERESVITA (MD)
Entity type:Individual
Prefix:DR
First Name:ERESVITA
Middle Name:
Last Name:BALATICO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ERESVITA
Other - Middle Name:
Other - Last Name:CABATU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 735
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:TN
Mailing Address - Zip Code:38478-0735
Mailing Address - Country:US
Mailing Address - Phone:931-363-8823
Mailing Address - Fax:931-363-1894
Practice Address - Street 1:1109 E. COLLEGE ST.
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:TN
Practice Address - Zip Code:38478
Practice Address - Country:US
Practice Address - Phone:931-363-8823
Practice Address - Fax:931-363-1894
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD141122080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNE04240Medicare UPIN