Provider Demographics
NPI:1184624140
Name:TIENG, EDWARD B (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:B
Last Name:TIENG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2001 LAUREL AVE
Mailing Address - Street 2:SUITE 502
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-1810
Mailing Address - Country:US
Mailing Address - Phone:865-331-9000
Mailing Address - Fax:865-331-7000
Practice Address - Street 1:2001 LAUREL AVE
Practice Address - Street 2:SUITE 502
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-1810
Practice Address - Country:US
Practice Address - Phone:865-331-9000
Practice Address - Fax:865-331-7000
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD0000039470208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1669416442OtherGROUP NPI
TN3329241Medicaid
TN3106057OtherBLUE CROSS
TNCI2260OtherRAILROAD MEDICARE
TN4104939OtherBLUE CROSS
TN020252399OtherEEOICP
TN3106057OtherBLUE CROSS
TNI28886Medicare UPIN
TN3329241Medicaid
TN103I348494Medicare PIN
TN1260440003Medicare NSC