Provider Demographics
NPI:1316914914
Name:VIROSLAV, ALICE B (MD)
Entity type:Individual
Prefix:DR
First Name:ALICE
Middle Name:B
Last Name:VIROSLAV
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 N PETERS RD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-2356
Mailing Address - Country:US
Mailing Address - Phone:865-694-0062
Mailing Address - Fax:
Practice Address - Street 1:8 CADILLAC DR
Practice Address - Street 2:SUITE 200
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5087
Practice Address - Country:US
Practice Address - Phone:615-376-7370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH90112085N0700X, 2085R0202X
TN457282085N0700X
IL036.1251462085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX117196904Medicaid
TX117196902Medicaid
TX117196906Medicaid
TX117196903OtherCSHCN
TX300125891Medicare PIN
81746RMedicare ID - Type Unspecified
TX351411YK00Medicare PIN
TX117196903OtherCSHCN
87061RMedicare ID - Type UnspecifiedSTRIC MEDICARE
TX117196906Medicaid