Provider Demographics
NPI:1043423874
Name:BANGALORE, SAMIR (MD)
Entity type:Individual
Prefix:DR
First Name:SAMIR
Middle Name:
Last Name:BANGALORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3443 DICKERSON PIKE STE 580
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37207-2526
Mailing Address - Country:US
Mailing Address - Phone:615-860-1040
Mailing Address - Fax:615-860-1242
Practice Address - Street 1:3443 DICKERSON PIKE STE 580
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37207-2526
Practice Address - Country:US
Practice Address - Phone:158-601-0606
Practice Address - Fax:158-601-2426
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV124622084N0400X
TN689592084N0400X, 2084E0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084E0001XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyEpilepsy
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1043423874Medicaid
AZ299316Medicaid
NV1043423874Medicaid
UT1043423874Medicaid
NVCR343ZMedicare PIN
P00473972Medicare PIN
NV1043423874Medicaid
NVV105684Medicare PIN