MEDICARE: DR. ASHWIN KISHTAGARI M.D.

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	207R00000X	Internal Medicine Physician	63376	TN
2	207RX0202X	Medical Oncology Physician	63376	TN
3	390200000X	Student in an Organized Health Care Education/Training Program
4	207RH0000X	Hematology (Internal Medicine) Physician	63376	TN

General Provider Information

NPI Number	:	1437565652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ASHWIN KISHTAGARI M.D.

Provider Business Mailing Address
First Line	:	3841 GREEN HILLS VILLAGE DR STE 200
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37215-2691
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3601 THE VANDERBILT CLINIC
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37232-1047
Country	:	US
Telephone Number	:	615-322-5000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2014
Last Update Date	:	03/24/2022

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