Provider Demographics
NPI:1366508681
Name:TUMKUR, DEEPIKA A (MD)
Entity Type:Individual
Prefix:
First Name:DEEPIKA
Middle Name:A
Last Name:TUMKUR
Suffix:
Gender:F
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:PO BOX 850
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37857-0850
Mailing Address - Country:US
Mailing Address - Phone:423-538-5116
Mailing Address - Fax:423-538-3861
Practice Address - Street 1:229 HIGHWAY 19 E
Practice Address - Street 2:
Practice Address - City:BLUFF CITY
Practice Address - State:TN
Practice Address - Zip Code:37618-1865
Practice Address - Country:US
Practice Address - Phone:423-538-5116
Practice Address - Fax:423-538-3861
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101246399207Q00000X
TN41795207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNI68943Medicare UPIN
103I082403Medicare PIN