Provider Demographics
NPI:1730186859
Name:PINELL, OCTAVIO J (MD)
Entity type:Individual
Prefix:DR
First Name:OCTAVIO
Middle Name:J
Last Name:PINELL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2002 BROOKSIDE DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4634
Mailing Address - Country:US
Mailing Address - Phone:423-392-6370
Mailing Address - Fax:423-392-6736
Practice Address - Street 1:2002 BROOKSIDE DR
Practice Address - Street 2:SUITE 300
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4634
Practice Address - Country:US
Practice Address - Phone:423-392-6370
Practice Address - Fax:423-392-6736
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2017-02-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TNMD017185207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3022087Medicaid
VA1730186859Medicaid
TN3709285Medicare UPIN
TN3022087Medicaid