Nazarov, Vitaly
Nazarov, Vitaly is an individual health care provider with primary practice located at 130 W Ravine Rd , Kingsport TN 37660-3837. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Hospitalist, Allopathic & Osteopathic Physicians / Internal Medicine. Allopathic & Osteopathic Physicians / Internal Medicine is his primary health care specialty. Nazarov, Vitaly can be contacted via phone (423) 224-3628.Contact Information
Primary practice address
130 W Ravine Rd
Kingsport TN 37660-3837
Phone: (423) 224-3628
Fax: (423) 230-8502
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Hospitalist | 208M00000X | 40147 | Tennessee |
| Allopathic & Osteopathic Physicians / Hospitalist | 208M00000X | 0101254975 | Virginia |
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 2017038349 | Missouri |
Profile Details
| NPI number | 1760469084 |
|---|---|
| LBN Legal business name | Nazarov, Vitaly |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 28th, 2005 |
| Last updated | Jul 6th, 2021 - about 3 years 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1760469084 | NPPES |
| Tennessee | Other | 4122077 | BCBST |
| Tennessee | Other | TN0119 | BCBST |
| Tennessee | MEDICAID | 3334533 | BCBST |
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