Provider Demographics
NPI:1891152104
Name:CARDIOLOGY & VASCULAR ASSOCIATES
Entity Type:Organization
Organization Name:CARDIOLOGY & VASCULAR ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:DINISH
Authorized Official - Middle Name:K
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-393-7831
Mailing Address - Street 1:1801 N JACKSON ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-8259
Mailing Address - Country:US
Mailing Address - Phone:931-393-7831
Mailing Address - Fax:931-393-7833
Practice Address - Street 1:1801 N JACKSON ST
Practice Address - Street 2:SUITE 100
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-2283
Practice Address - Country:US
Practice Address - Phone:931-393-7831
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-19
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN24987207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty