MEDICARE: SAMYUKTA MULLANGI MD

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	294051	NY
2	207RH0003X	Hematology & Oncology Physician	68193	TN

General Provider Information

NPI Number	:	1598143497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMYUKTA MULLANGI MD

Provider Business Mailing Address
First Line	:	2004 HAYES ST STE 800
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37203-2659
Country	:	US
Telephone Number	:	615-329-0570
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 NATCHEZ PARK DR STE 103
Second Line	:
City	:	DICKSON
State	:	TN
Zip	:	37055-9013
Country	:	US
Telephone Number	:	615-740-7025
Fax Number	:

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

Provider Enumeration Date	:	05/12/2015
Last Update Date	:	09/26/2023

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