Individual
SUSAN BOCCAROSSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
240 MEDICAL PARK BLVD, STE 3600, BRISTOL, TN 37620-7349
(423) 990-2414
Mailing address
PO BOX 9, KINGSPORT, TN 37662-0009
(423) 857-2066
(423) 857-2070
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD 29434
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5830508
—
VA
Enumeration date
06/09/2005
Last updated
01/03/2008
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