Provider Demographics
NPI:1639456866
Name:DAS, DEBALINA (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBALINA
Middle Name:
Last Name:DAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 699
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:TN
Mailing Address - Zip Code:37684-0699
Mailing Address - Country:US
Mailing Address - Phone:423-433-6065
Mailing Address - Fax:423-433-6060
Practice Address - Street 1:325 N STATE OF FRANKLIN RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604
Practice Address - Country:US
Practice Address - Phone:423-439-7280
Practice Address - Fax:423-439-7314
Is Sole Proprietor?:No
Enumeration Date:2011-11-16
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD52886207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ013691Medicaid