Provider Demographics
NPI:1780634691
Name:ODDONO, ERNEST J JR (MD)
Entity type:Individual
Prefix:
First Name:ERNEST
Middle Name:J
Last Name:ODDONO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:131 SAUNDERSVILLE RD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-8903
Mailing Address - Country:US
Mailing Address - Phone:615-824-3737
Mailing Address - Fax:855-540-4722
Practice Address - Street 1:131 SAUNDERSVILLE RD
Practice Address - Street 2:SUITE 180
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-8903
Practice Address - Country:US
Practice Address - Phone:615-824-3737
Practice Address - Fax:855-540-4722
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC9400116207L00000X
NC94001169400116208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8963680Medicaid
VA5714541Medicaid
NC63680OtherBCBS
NC2222037BMedicare ID - Type Unspecified
NC63680OtherBCBS