Provider Demographics
NPI:1629017025
Name:BOICIUC, MIRCEA (MD)
Entity Type:Individual
Prefix:DR
First Name:MIRCEA
Middle Name:
Last Name:BOICIUC
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 9
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37662-0009
Mailing Address - Country:US
Mailing Address - Phone:423-857-2066
Mailing Address - Fax:423-857-2070
Practice Address - Street 1:2033 MEADOWVIEW LN
Practice Address - Street 2:STE 200
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-7569
Practice Address - Country:US
Practice Address - Phone:423-857-2793
Practice Address - Fax:423-578-8025
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN40362208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1629017025Medicaid
TN33360251Medicaid
TN0281780003Medicare PIN
TN0281780001Medicare PIN
TN103I117680Medicare PIN
TN103I086169Medicare UPIN
VA1629017025Medicaid
G77349Medicare UPIN
TN33360251Medicare PIN