Individual
VIDYA RAMAKRISHNAIAH BANSAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
111 OTIS SMITH DR, CLARKSVILLE, TN 37043
(931) 553-6666
Mailing address
111 OTIS SMITH DR, CLARKSVILLE, TN 37043-8940
(931) 553-6666
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
35 090073
OH
208000000X
Pediatrics Physician
Primary
43833
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q035503
—
TN
Enumeration date
08/16/2007
Last updated
06/21/2018
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