Provider Demographics
NPI:1720082126
Name:GOENKA, PUNEET (MD)
Entity Type:Individual
Prefix:
First Name:PUNEET
Middle Name:
Last Name:GOENKA
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 1:310 N STATE OF FRANKLIN RD
Mailing Address - Street 2:STE 202
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-6063
Mailing Address - Country:US
Mailing Address - Phone:423-929-7111
Mailing Address - Fax:423-929-9448
Practice Address - Street 1:310 N STATE OF FRANKLIN RD
Practice Address - Street 2:STE 202
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-6063
Practice Address - Country:US
Practice Address - Phone:423-929-7111
Practice Address - Fax:423-929-9448
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD27475207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F62782Medicare UPIN
TN3840375Medicare ID - Type Unspecified