MEDICARE: DR. VIOREL MANOLE 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	207Q00000X	Family Medicine Physician	0101235496	VA
2	207Q00000X	Family Medicine Physician	MD33801	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639172711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIOREL MANOLE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 9
Second Line	:
City	:	KINGSPORT
State	:	TN
Zip	:	37662-0009
Country	:	US
Telephone Number	:	423-857-2066
Fax Number	:	423-857-2070

Provider Business Practice Location Address
First Line	:	406 E MAIN BLVD
Second Line	:
City	:	CHURCH HILL
State	:	TN
Zip	:	37642-3414
Country	:	US
Telephone Number	:	423-357-6761
Fax Number	:	423-357-2868

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	09/22/2009

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