Provider Demographics
NPI:1962495879
Name:BARON, MICHAEL B (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:B
Last Name:BARON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 EXECUTIVE PARK BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4632
Mailing Address - Country:US
Mailing Address - Phone:423-224-3250
Mailing Address - Fax:423-224-3258
Practice Address - Street 1:271 MEDICAL PARK BLVD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-7455
Practice Address - Country:US
Practice Address - Phone:423-968-2311
Practice Address - Fax:423-968-2312
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000027671207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA290009065OtherPALMETTO RR MEDICARE
VA290000156OtherTRAILBLAZERS MEDICARE
TN290009065OtherPALMETTO RR MEDICARE
KY6472118600Medicaid
TN3098673Medicaid
VAV V5965AMedicare PIN
VA018372W82Medicare PIN
TN103I292913Medicare PIN
VA290009065OtherPALMETTO RR MEDICARE
TNP00369988Medicare PIN
VA290000156OtherTRAILBLAZERS MEDICARE
TNB76290Medicare UPIN