Basic Information
| Provider Information | |||||||||
| NPI: | 1235172164 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HADDAD | ||||||||
| FirstName: | ELIAS | ||||||||
| MiddleName: | V | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4230 HARDING PIKE | ||||||||
| Address2: | STE 330 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372052018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152694545 | ||||||||
| FaxNumber: | 6155656748 | ||||||||
| Practice Location | |||||||||
| Address1: | 1215 21ST AVE S | ||||||||
| Address2: | SUITE 5100 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372320014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153222318 | ||||||||
| FaxNumber: | 6158756181 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2006 | ||||||||
| LastUpdateDate: | 05/12/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 39630 | TN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RI0011X | 39630 | TN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | 207RC0000X | 39630 | TN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 3333478 | 05 | TN | MEDICAID | 6411924100 | 01 | KY | KENTUCKY MEDICAID | OTHER | 7121802 | 01 | AETNA | OTHER | 4141588 | 01 | TN | BLUE CROSS | OTHER | P00395861 | 01 | RAILROAD MEDICARE | OTHER | 4119774 | 01 | TN | BCBS | OTHER |