Provider Demographics
NPI:1699763250
Name:MISTRY, NARESH R (MD)
Entity type:Individual
Prefix:
First Name:NARESH
Middle Name:R
Last Name:MISTRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:689 MEDICAL PARK DR STE 301
Mailing Address - Street 2:
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37772-5798
Mailing Address - Country:US
Mailing Address - Phone:865-986-8121
Mailing Address - Fax:865-986-8124
Practice Address - Street 1:689 MEDICAL PARK DR STE 301
Practice Address - Street 2:
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37772-5798
Practice Address - Country:US
Practice Address - Phone:865-986-8121
Practice Address - Fax:865-986-8124
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2024-04-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TNMD27232207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3095854Medicaid
TN3095854Medicaid
E44398Medicare UPIN