Basic Information
Provider Information
NPI: 1457563728
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NADEAU
FirstName: BENJAMIN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 440100
Address2:  
City: NASHVILLE
State: TN
PostalCode: 372440100
CountryCode: US
TelephoneNumber: 4236981844
FaxNumber:  
Practice Location
Address1: 605 GLENWOOD DR
Address2: SUITE 200
City: CHATTANOOGA
State: TN
PostalCode: 374041108
CountryCode: US
TelephoneNumber: 4236981844
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/07/2007
LastUpdateDate: 01/12/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RH0003X48761TNY Allopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
207RH0003X68076GAN Allopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology

No ID Information.


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