Provider Demographics
NPI:1316919905
Name:PIERCE, DARYL WAYNE (MD)
Entity type:Individual
Prefix:
First Name:DARYL
Middle Name:WAYNE
Last Name:PIERCE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 PAVILION DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4641
Mailing Address - Country:US
Mailing Address - Phone:423-857-6466
Mailing Address - Fax:423-857-6456
Practice Address - Street 1:2205 PAVILION DR
Practice Address - Street 2:SUITE 101
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4641
Practice Address - Country:US
Practice Address - Phone:423-857-6466
Practice Address - Fax:423-857-6456
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101231036207RH0003X
TN35145207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1316919905Medicaid
VAP01632630OtherRAILROAD MEDICARE
TNQ020753Medicaid
VA017906W85Medicare PIN
VAV V5987AMedicare PIN
TN3867151Medicare PIN
TN103I821912Medicare PIN
TN103I822862Medicare PIN
VAP00622856Medicare PIN
VAP01632630OtherRAILROAD MEDICARE
VA1316919905Medicaid
VAVV5987BMedicare PIN
TN3867150Medicare PIN
TNQ020753Medicaid