Provider Demographics
NPI:1669458857
Name:BAKSHI, MANDEEP S (MD)
Entity Type:Individual
Prefix:
First Name:MANDEEP
Middle Name:S
Last Name:BAKSHI
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 1:1404 TUSCULUM BLVD 2200
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37745-4395
Mailing Address - Country:US
Mailing Address - Phone:423-798-8052
Mailing Address - Fax:423-798-8055
Practice Address - Street 1:401 TAKOMA AVE
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37743-4647
Practice Address - Country:US
Practice Address - Phone:423-278-1743
Practice Address - Fax:423-278-1930
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38797207RS0012X
TNMD38797208M00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1522612Medicaid
TN4330458OtherBCBS OF TN
NC891087YMedicaid
TN103I489125Medicare PIN
TN1522612Medicaid
TN103I113721Medicare PIN
G62955Medicare UPIN