Provider Demographics
NPI:1295818409
Name:SMELYANSKY, IGOR (MD)
Entity Type:Individual
Prefix:
First Name:IGOR
Middle Name:
Last Name:SMELYANSKY
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:PO BOX 32965
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37930-2965
Mailing Address - Country:US
Mailing Address - Phone:865-337-5137
Mailing Address - Fax:865-312-8350
Practice Address - Street 1:6348 LONAS SPRING DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-2719
Practice Address - Country:US
Practice Address - Phone:865-337-5137
Practice Address - Fax:888-839-6922
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN476832084P2900X, 2084P2900X
NY2304152084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1524684Medicaid
TN1524684Medicaid
TN103I721567Medicare PIN
NY533N71Medicare ID - Type UnspecifiedEMPIRE MEDICARE BROOKLYN
NYY05995OtherGHI MEDICARE UPIN QUEENS