Provider Demographics
NPI:1609971134
Name:COLLETTI, RICHARD A (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:COLLETTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 HOLIDAY CT
Mailing Address - Street 2:D-09
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-3000
Mailing Address - Country:US
Mailing Address - Phone:615-636-1188
Mailing Address - Fax:888-381-3549
Practice Address - Street 1:109 HOLIDAY CT., D10
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067
Practice Address - Country:US
Practice Address - Phone:615-636-1188
Practice Address - Fax:888-381-3549
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN413672084P0804X
VA01012544532084P0804X
CAA830812084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN262016109OtherTAX ID