Basic Information
| Provider Information | |||||||||
| NPI: | 1578501904 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TESAURO | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2300 PATTERSON ST | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372031538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153426828 | ||||||||
| FaxNumber: | 6153426836 | ||||||||
| Practice Location | |||||||||
| Address1: | 2300 PATTERSON ST | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372031538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153426828 | ||||||||
| FaxNumber: | 6153426836 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2006 | ||||||||
| LastUpdateDate: | 02/10/2022 | ||||||||
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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 | 207RC0000X | 27156 | TN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RH0002X | 27156 | TN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hospice and Palliative Medicine | 207R00000X | 27156 | TN | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3826562 | 05 | TN | MEDICAID | 4141663 | 01 | TN | BLUE CROSS | OTHER | P00394317 | 01 | RAIDROAD MEDICARE | OTHER | 5730652 | 01 | AETNA | OTHER | 6471248200 | 01 | KY | KENTUCKY MEDICAID | OTHER | 3826560 | 01 | MEDICARE | OTHER | 6011197 | 01 | TN | BLUE CROSS-BLUE SHIELD | OTHER | 3097898 | 01 | TN | BCBS | OTHER |