Provider Demographics
NPI:1770578593
Name:MISRA, REETA (MD)
Entity type:Individual
Prefix:
First Name:REETA
Middle Name:
Last Name:MISRA
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 1:310 25TH AVE N
Mailing Address - Street 2:SUITE 303
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1515
Mailing Address - Country:US
Mailing Address - Phone:615-333-1440
Mailing Address - Fax:615-333-9639
Practice Address - Street 1:3443 DICKERSON PIKE
Practice Address - Street 2:STE 370
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37207-2519
Practice Address - Country:US
Practice Address - Phone:615-865-5830
Practice Address - Fax:615-865-5831
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD14738208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3033269Medicaid
A99686Medicare UPIN