Provider Demographics
NPI:1568548006
Name:XENOPOULOS, NICHOLAS PETER (MD)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:PETER
Last Name:XENOPOULOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:NICHOLAOS
Other - Middle Name:PETER
Other - Last Name:XENOPOULOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:9330 PARK WEST BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4308
Mailing Address - Country:US
Mailing Address - Phone:865-691-4850
Mailing Address - Fax:865-539-5073
Practice Address - Street 1:9330 PARK WEST BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4308
Practice Address - Country:US
Practice Address - Phone:865-691-4850
Practice Address - Fax:865-539-5073
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32179207RC0000X
IN01046596A207RC0000X
TN39685207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY25-00486OtherUNITED HEALTHCARE
KY000000112862OtherANTHEM BCBS
IN200106000Medicaid
3154073OtherBCBS TENNESSEE
KY5156752OtherAETNA
7233954008OtherCIGNA
KY060058270OtherRAILROAD MEDICARE
1166305OtherCHA PROVIDER NETWORK
KY299856OtherFEDERAL BLACK LUNG PROGRA
KY1116387OtherPASSPORT HEALTH PLAN
KY6113371060A12OtherANTHEM SR. ADVANTAGE
KY64321797Medicaid
IN415632POtherSIHO
TN3734041Medicare PIN
3154073OtherBCBS TENNESSEE
7233954008OtherCIGNA
KY0875303Medicare ID - Type UnspecifiedTOMPKINSVILLE
IN200106000Medicaid
KY299856OtherFEDERAL BLACK LUNG PROGRA
TN103I065780Medicare PIN