Individual
SHOBHA R. HIREMAGALUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
310 N STATE OF FRANKLIN RD, SUITE 400, JOHNSON CITY, TN 37604-6008
(423) 979-6000
(423) 979-6011
Mailing address
310 N STATE OF FRANKLIN RD, SUITE 400, JOHNSON CITY, TN 37604-6008
(423) 979-6000
(423) 979-6011
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
24677
TN
207RC0000X
Cardiovascular Disease Physician
MD24677
TN
207RI0011X
Interventional Cardiology Physician
Primary
24677
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1407841398
—
VA
05
—
3086995
—
TN
05
—
64001035
—
KY
01
—
P01368158
RAILROAD MEDICARE
TN
Enumeration date
09/16/2005
Last updated
02/09/2017
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