Basic Information
| Provider Information | |||||||||
| NPI: | 1073516340 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TEDDER | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 GREAT CIRCLE RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372281317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152227685 | ||||||||
| FaxNumber: | 6152227237 | ||||||||
| Practice Location | |||||||||
| Address1: | 4230 HARDING PIKE | ||||||||
| Address2: | SUITE 430 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372052013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153854781 | ||||||||
| FaxNumber: | 6153859265 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2005 | ||||||||
| LastUpdateDate: | 08/16/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | MD029206 | TN | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | 4334022 | 01 | TN | BCBST | OTHER | P01004440 | 01 | TN | RR MEDICARE | OTHER | 3812958 | 05 | TN | MEDICAID | 0995624 | 01 | TN | AETNA HMO | OTHER | 1840022 | 01 | TN | UNITED HEALTHCARE | OTHER | 01616927 | 01 | TN | AMERIGROUP | OTHER | 5463506 | 01 | TN | AETNA PPO | OTHER | 8773249003 | 01 | TN | CIGNA PPO | OTHER | 8773249004 | 01 | TN | CIGNA HMO | OTHER |