Provider Demographics
NPI:1710970793
Name:HOSKERE, GIRENDRA V (MD)
Entity Type:Individual
Prefix:
First Name:GIRENDRA
Middle Name:V
Last Name:HOSKERE
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 STE 205E
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-7507
Practice Address - Country:US
Practice Address - Phone:423-844-5520
Practice Address - Fax:423-844-5521
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN31670207RC0200X, 207RS0012X, 208M00000X, 207RP1001X
VA0101244855207RC0200X, 207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3847700Medicaid
TN201217521OtherPHP (IPC OF TN)
TN4137448OtherBCBST (IPC OF TN)
TNTN0138OtherJOHN DEERE (IPC OF TN)
TN4137448OtherBCBST (IPC OF TN)
TN3847708Medicare ID - Type Unspecified
TN103I295891Medicare PIN
TN201217521OtherPHP (IPC OF TN)
TN3847700Medicaid
TN3847700Medicare PIN
TN103I112816Medicare PIN