Provider Demographics
NPI:1336222546
Name:VIRANI, SUBHASH (MD)
Entity type:Individual
Prefix:DR
First Name:SUBHASH
Middle Name:
Last Name:VIRANI
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 1:519 GRAND MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-7426
Mailing Address - Country:US
Mailing Address - Phone:423-899-5241
Mailing Address - Fax:423-894-7312
Practice Address - Street 1:1720 GUNBARREL RD
Practice Address - Street 2:SUITE 110
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3192
Practice Address - Country:US
Practice Address - Phone:423-899-5241
Practice Address - Fax:423-894-7312
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD30631207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4102755OtherBLUE CROSS GROUP #
TNP00209716OtherRAILROAD MEDICARE
TN4102754OtherBLUE CROSS INDIVIDUAL #
TNG86990Medicare UPIN
TN3724279Medicare ID - Type UnspecifiedGROUP NUMBER
TN4102755OtherBLUE CROSS GROUP #