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Organization
STATUS ALLERGY CLINIC OF KINGSPORT
Active
Organization
STATUS ALLERGY CLINIC OF KINGSPORT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NALINCHANDRA GOPALDAS SHAH MD (PRESIDENT - MD)
(423) 247-1122
Entity
Organization
Contact information
Practice address
1516 BRIDGEWATER DR., KINGSPORT, TN 37660
(423) 247-1122
(423) 247-3856
Mailing address
P.O. BOX 3490, KINGSPORT, TN 37664
(423) 247-1122
(423) 247-3856
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
MD0000015776
TN
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
MD0000015776
TN
Other
Enumeration date
09/16/2010
Last updated
09/16/2010
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