Healthcare Provider Details

I. General information

NPI: 1891952313
Provider Name (Legal Business Name): SYAMAL DAVE BHATTACHARYA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 07/29/2020
Certification Date: 07/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

979 E 3RD ST STE. 300
CHATTANOOGA TN
37403-2136
US

IV. Provider business mailing address

979 E 3RD ST STE. 300
CHATTANOOGA TN
37403-2136
US

V. Phone/Fax

Practice location:
  • Phone: 423-267-0466
  • Fax:
Mailing address:
  • Phone: 423-267-0466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number54609
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: