Basic Information
| Provider Information | |||||||||
| NPI: | 1164488078 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ACCHIARDO | ||||||||
| FirstName: | SERGIO | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 66 N PAULINE ST | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381055105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9014482869 | ||||||||
| FaxNumber: | 9014481772 | ||||||||
| Practice Location | |||||||||
| Address1: | 1910 NONCONNAH BLVD | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381322113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9014482300 | ||||||||
| FaxNumber: | 9014486657 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2006 | ||||||||
| LastUpdateDate: | 08/08/2007 | ||||||||
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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 | 207RN0300X | 7266 | TN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 2005285 | 01 | TN | BC/BS TENNESSEE | OTHER | 3155093 | 05 | TN | MEDICAID |