Mudigonda, Tejaswi Venkata

Mudigonda, Tejaswi Venkata is an sole proprietor health care provider with primary practice located at 1424 W Baddour Pkwy Ste G , Lebanon TN 37087-2685. He recently has 4 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Dermatopathology, Allopathic & Osteopathic Physicians / Procedural Dermatology, Allopathic & Osteopathic Physicians / Dermatology, Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery. Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery is his primary health care specialty. Mudigonda, Tejaswi Venkata can be contacted via phone (615) 314-1699.

Contact Information

Primary practice address
1424 W Baddour Pkwy Ste G Lebanon TN 37087-2685
Phone: (615) 314-1699
Fax: (615) 622-8905
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Dermatopathology 207ND0900X 68967 Tennessee
Allopathic & Osteopathic Physicians / Procedural Dermatology 207NS0135X 68967 Tennessee
Allopathic & Osteopathic Physicians / Dermatology 207N00000X 68967 Tennessee
Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery 207ND0101X 68967 Tennessee

Profile Details

NPI number 1891143277
LBN Legal business name Mudigonda, Tejaswi Venkata
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date May 26th, 2016
Last updated Mar 12th, 2024 - about 8 months ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1891143277 NPPES
Oklahoma MEDICAID 207R00000X

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