Basic Information
| Provider Information | |||||||||
| NPI: | 1710970793 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOSKERE | ||||||||
| FirstName: | GIRENDRA | ||||||||
| MiddleName: | V | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 105 W. STONE DR. | ||||||||
| Address2: | SUITE 6A | ||||||||
| City: | KINGSPORT | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376603365 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234087220 | ||||||||
| FaxNumber: | 4234087405 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 MEDICAL PARK BLVD STE 205E | ||||||||
| Address2: | |||||||||
| City: | BRISTOL | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376207507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4238445520 | ||||||||
| FaxNumber: | 4238445521 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2005 | ||||||||
| LastUpdateDate: | 08/24/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | 31670 | TN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RC0200X | 0101244855 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RP1001X | 0101244855 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RS0012X | 31670 | TN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine | 207RS0012X | 0101244855 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine | 208M00000X | 31670 | TN | N | Allopathic & Osteopathic Physicians | Hospitalist | 207RP1001X | 31670 | TN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 3847700 | 05 | TN | MEDICAID | 201217521 | 01 | TN | PHP (IPC OF TN) | OTHER | 4137448 | 01 | TN | BCBST (IPC OF TN) | OTHER | TN0138 | 01 | TN | JOHN DEERE (IPC OF TN) | OTHER |