Healthcare Provider Details

I. General information

NPI: 1053638734
Provider Name (Legal Business Name): SAMUEL CHAND TYAGI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2010
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE ST # C212
LEXINGTON KY
40536-7001
US

IV. Provider business mailing address

1237 HARDING PL #4400
CHARLOTTE NC
28204
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-6602
  • Fax: 859-323-6840
Mailing address:
  • Phone: 704-373-0212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number97267
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number03534
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number50119
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: