Healthcare Provider Details

I. General information

NPI: 1629017025
Provider Name (Legal Business Name): MIRCEA BOICIUC M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 05/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2033 MEADOWVIEW LN STE 200
KINGSPORT TN
37660-7569
US

IV. Provider business mailing address

PO BOX 9
KINGSPORT TN
37662-0009
US

V. Phone/Fax

Practice location:
  • Phone: 423-857-2793
  • Fax: 423-578-8025
Mailing address:
  • Phone: 423-857-2066
  • Fax: 423-857-2070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number40362
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: