Provider Demographics
NPI:1679559165
Name:BRAHMBHATT, VIPULKUMAR R (MD)
Entity Type:Individual
Prefix:
First Name:VIPULKUMAR
Middle Name:R
Last Name:BRAHMBHATT
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 1:1021 W OAKLAND AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2192
Mailing Address - Country:US
Mailing Address - Phone:423-302-6565
Mailing Address - Fax:
Practice Address - Street 1:310 N STATE OF FRANKLIN RD STE 400
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-6051
Practice Address - Country:US
Practice Address - Phone:423-979-6000
Practice Address - Fax:423-979-6011
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN039886207RC0000X
WI51930207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5912618Medicaid
KY64112550Medicaid
TN3333835Medicaid
TN4232015OtherBLUE CROSS BLUE SHIELD
WI100134513Medicaid
7696872OtherCIGNA
0007697614OtherAETNA
VA1679559165Medicaid
TN33338352Medicare PIN
VA1679559165Medicaid
TN103I111237Medicare PIN