Provider Demographics
NPI:1609099035
Name:BAZZANI, PRIYA D (MD)
Entity Type:Individual
Prefix:
First Name:PRIYA
Middle Name:D
Last Name:BAZZANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PRIYA
Other - Middle Name:D
Other - Last Name:LUTHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:28 WHITE BRIDGE RD
Mailing Address - Street 2:STE. 300
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-1492
Mailing Address - Country:US
Mailing Address - Phone:615-356-4111
Mailing Address - Fax:615-356-8011
Practice Address - Street 1:28 WHITE BRIDGE RD
Practice Address - Street 2:STE. 300
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-1492
Practice Address - Country:US
Practice Address - Phone:615-356-4111
Practice Address - Fax:615-356-8011
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN45140207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1515437Medicaid
TN1515437Medicaid