Provider Demographics
NPI:1639172711
Name:MANOLE, VIOREL (MD)
Entity type:Individual
Prefix:DR
First Name:VIOREL
Middle Name:
Last Name:MANOLE
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:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37662-0009
Mailing Address - Country:US
Mailing Address - Phone:423-857-2066
Mailing Address - Fax:423-857-2070
Practice Address - Street 1:406 E MAIN BLVD
Practice Address - Street 2:
Practice Address - City:CHURCH HILL
Practice Address - State:TN
Practice Address - Zip Code:37642-3414
Practice Address - Country:US
Practice Address - Phone:423-357-6761
Practice Address - Fax:423-357-2868
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101235496207Q00000X
TNMD33801207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA09999400Medicaid
TN3854134Medicaid
VA006402H81Medicare UPIN
VA006402H81Medicare ID - Type Unspecified
VA006402H81Medicare PIN
TN103I086169Medicare UPIN
TN110220427Medicare PIN
TN0281780001Medicare PIN
TN3854134Medicaid
TNCA5023Medicare PIN
TN3854139Medicare ID - Type Unspecified
TN0281780003Medicare PIN