Basic Information
| Provider Information | |||||||||
| NPI: | 1619530797 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DILORETO | ||||||||
| FirstName: | NICHOLAS | ||||||||
| MiddleName: | ALEXANDER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1500 W POPLAR AVE | ||||||||
| Address2: | |||||||||
| City: | COLLIERVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380170601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9018619000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1500 W POPLAR AVE | ||||||||
| Address2: | |||||||||
| City: | COLLIERVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380170601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9018619000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2019 | ||||||||
| LastUpdateDate: | 06/27/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | 0000064871 | TN | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.