Individual
DR. VITALY GENNADIEVICH NAZAROV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
130 W RAVINE RD, KINGSPORT, TN 37660-3837
(423) 224-3628
(423) 230-8502
Mailing address
105 W STONE DR, SUITE 6A, KINGSPORT, TN 37660-3365
(423) 408-7220
(423) 408-7405
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
2017038349
MO
208M00000X
Hospitalist Physician
0101254975
VA
208M00000X
Hospitalist Physician
40147
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3334533
—
TN
01
—
4122077
BCBST
TN
01
—
TN0119
JOHN DEERE HEATLHCARE
TN
Enumeration date
12/28/2005
Last updated
11/21/2025
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