Provider Demographics
NPI:1730969122
Name:PRANA PULMONARY CLINIC PLLC
Entity type:Organization
Organization Name:PRANA PULMONARY CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:VIJOYDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:TANJORE VENKOBA RAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-310-2504
Mailing Address - Street 1:4069 WELLINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-1697
Mailing Address - Country:US
Mailing Address - Phone:865-310-2504
Mailing Address - Fax:
Practice Address - Street 1:230 BOWMAN ST STE B
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813-3871
Practice Address - Country:US
Practice Address - Phone:423-501-7241
Practice Address - Fax:423-501-7242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-03
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty