Provider Demographics
NPI:1952375834
Name:BARONGAN, AMOR A (MD)
Entity Type:Individual
Prefix:DR
First Name:AMOR
Middle Name:A
Last Name:BARONGAN
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 1:999 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 1:280 VIRGINIA AVENUE
Practice Address - Street 2:SUITE 107
Practice Address - City:NORTON
Practice Address - State:VA
Practice Address - Zip Code:24273
Practice Address - Country:US
Practice Address - Phone:276-679-4455
Practice Address - Fax:276-679-5416
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA010121772207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010173426Medicaid
VAC36691Medicare UPIN
VAP00240442Medicare PIN
VAV V5966AMedicare PIN
VA008280W83Medicare PIN