MEDICARE: SIBAJI SHOME MD PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician	24694	TN

General Provider Information

NPI Number	:	1962722496
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIBAJI SHOME MD PLLC

Provider Business Mailing Address
First Line	:	PO BOX 240
Second Line	:
City	:	SIGNAL MOUNTAIN
State	:	TN
Zip	:	37377-0240
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7155 LEE HWY
Second Line	:	SUITE 400
City	:	CHATTANOOGA
State	:	TN
Zip	:	37421-0800
Country	:	US
Telephone Number	:	423-499-2637
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SIBAJI SHOME
Credential	:	MD
Telephone Number	:	336-310-4712

Provider Enumeration Date	:	06/07/2010
Last Update Date	:	06/07/2010

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