MEDICARE: DR. MARVIN E LYMBERIS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	13334	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477530160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARVIN E LYMBERIS M.D.

Provider Business Mailing Address
First Line	:	1920 BROOKSIDE DR
Second Line	:	SUITE 9
City	:	KINGSPORT
State	:	TN
Zip	:	37660-4613
Country	:	US
Telephone Number	:	423-246-2040
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 BROOKSIDE DR
Second Line	:
City	:	KINGSPORT
State	:	TN
Zip	:	37660-4627
Country	:	US
Telephone Number	:	423-857-7000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/23/2005
Last Update Date	:	05/25/2010

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