Provider Demographics
NPI:1134120777
Name:CIRELLI, STEPHEN R (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:R
Last Name:CIRELLI
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 1:999 EXECUTIVE PARK BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4632
Mailing Address - Country:US
Mailing Address - Phone:423-224-3250
Mailing Address - Fax:423-224-3258
Practice Address - Street 1:851 LOCUST ST
Practice Address - Street 2:
Practice Address - City:ROGERSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37857-2407
Practice Address - Country:US
Practice Address - Phone:423-272-2671
Practice Address - Fax:423-272-7667
Is Sole Proprietor?:No
Enumeration Date:2005-08-04
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200201566207R00000X
TN40343207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC13230OtherBCBS INDIVIDUAL PROVIDER
KY7100053310Medicaid
NC8913230Medicaid
WV3810012222Medicaid
NCE28128Medicare UPIN
NC8913230Medicaid
TN103I112934Medicare PIN
WV3810012222Medicaid
NC13230OtherBCBS INDIVIDUAL PROVIDER
TN3001055Medicare PIN
NC2011286AMedicare PIN