Provider Demographics
NPI:1619088960
Name:SOMAYAJI GASTROENTEROLOGY GROUP, PC
Entity Type:Organization
Organization Name:SOMAYAJI GASTROENTEROLOGY GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BUNTWAL
Authorized Official - Middle Name:N
Authorized Official - Last Name:SOMAYAJI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-329-7820
Mailing Address - Street 1:2010 CHURCH ST
Mailing Address - Street 2:SUITE 508
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2012
Mailing Address - Country:US
Mailing Address - Phone:615-329-7820
Mailing Address - Fax:
Practice Address - Street 1:2010 CHURCH ST
Practice Address - Street 2:SUITE 508
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2012
Practice Address - Country:US
Practice Address - Phone:615-329-7820
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD007279207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3702086Medicaid
TN3031055OtherBCBS
TN3702086Medicaid
TN3031055OtherBCBS