Provider Demographics
NPI:1922022672
Name:SHOME, SIBAJI (MD)
Entity Type:Individual
Prefix:
First Name:SIBAJI
Middle Name:
Last Name:SHOME
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 1:206 MATHES LN
Mailing Address - Street 2:
Mailing Address - City:SIGNAL MOUNTAIN
Mailing Address - State:TN
Mailing Address - Zip Code:37377-2266
Mailing Address - Country:US
Mailing Address - Phone:423-629-5098
Mailing Address - Fax:423-629-6078
Practice Address - Street 1:979 E 3RD ST STE A-240
Practice Address - Street 2:A-240
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2136
Practice Address - Country:US
Practice Address - Phone:423-778-5199
Practice Address - Fax:423-778-2112
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000024694207RP1001X
TN0024694207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0000024694OtherMD
TNF00746Medicare UPIN
TN3881875Medicare ID - Type UnspecifiedMEDICARE