Provider Demographics
NPI:1841484359
Name:DALLAKOTI, NISHAN (MD)
Entity type:Individual
Prefix:
First Name:NISHAN
Middle Name:
Last Name:DALLAKOTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5410 MARYLAND WAY
Mailing Address - Street 2:SUITE 300 COGENT HEALTHCARE
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027
Mailing Address - Country:US
Mailing Address - Phone:615-377-5600
Mailing Address - Fax:615-373-5280
Practice Address - Street 1:1101 26TH ST S
Practice Address - Street 2:COGENT HEALTHCARE OF MONTANA, PC
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405
Practice Address - Country:US
Practice Address - Phone:405-455-4690
Practice Address - Fax:405-455-4691
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA261721208M00000X
MT12363208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist