Provider Demographics
NPI:1679518989
Name:ISTFAN, PIERRE (MD)
Entity Type:Individual
Prefix:DR
First Name:PIERRE
Middle Name:
Last Name:ISTFAN
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 1:105 W STONE DR
Mailing Address - Street 2:SUITE 6A
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-3365
Mailing Address - Country:US
Mailing Address - Phone:423-408-7220
Mailing Address - Fax:423-408-7405
Practice Address - Street 1:1 MEDICAL PARK BLVD
Practice Address - Street 2:SUITE 458W
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620
Practice Address - Country:US
Practice Address - Phone:423-844-4800
Practice Address - Fax:423-230-6905
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21551207RC0000X, 207RI0011X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3061017Medicaid
TN621112685OtherUNITED HEALTH CARE
TN060041210Medicaid
KY64928450Medicaid
VA5806232Medicaid
KY64928450Medicaid
TNE90505Medicare UPIN