Healthcare Provider Details

I. General information

NPI: 1124251970
Provider Name (Legal Business Name): HARISH BANGALORE SIDDAIAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2009
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 THE VANDERBILT CLINIC AVE
NASHVILLE TN
37232-5100
US

IV. Provider business mailing address

3841 GREEN HILLS VILLAGE DR STE 200
NASHVILLE TN
37215-2691
US

V. Phone/Fax

Practice location:
  • Phone: 615-322-5000
  • Fax:
Mailing address:
  • Phone: 615-322-5000
  • Fax: 318-675-6681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number247027
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberE-17633
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD.207326
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: