Provider Demographics
NPI:1891998092
Name:LOSINSKI, TIANA NOELLE (MD)
Entity Type:Individual
Prefix:
First Name:TIANA
Middle Name:NOELLE
Last Name:LOSINSKI
Suffix:
Gender:F
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 1845
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28687-1845
Mailing Address - Country:US
Mailing Address - Phone:704-873-4277
Mailing Address - Fax:704-873-4511
Practice Address - Street 1:206 JOE V KNOX AVE
Practice Address - Street 2:SUITE J
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8528
Practice Address - Country:US
Practice Address - Phone:704-360-4801
Practice Address - Fax:704-696-2565
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-00606207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5907288Medicaid
P00431024Medicare PIN
2067285Medicare PIN