Healthcare Provider Details

I. General information

NPI: 1043423874
Provider Name (Legal Business Name): SAMIR BANGALORE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3443 DICKERSON PIKE STE 580
NASHVILLE TN
37207-2526
US

IV. Provider business mailing address

3443 DICKERSON PIKE STE 580
NASHVILLE TN
37207-2526
US

V. Phone/Fax

Practice location:
  • Phone: 158-601-0606
  • Fax: 158-601-2426
Mailing address:
  • Phone: 615-860-1040
  • Fax: 615-860-1242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number12462
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number68959
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License Number68959
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: