Susan Boccarossa, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

MD 29434 Issued in TN

Practice address

240 Medical Park Blvd
Ste 3600
Bristol, TN 37620-7349

Phone

(423) 990-2414

NPI assigned

Jun 9, 2005

Last updated

Jan 3, 2008By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1118275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1199318400000",
    "number": "1861496622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376620009",
            "telephone_number": "423-857-2066",
            "fax_number": "423-857-2070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 MEDICAL PARK BLVD",
            "address_2": "STE 3600",
            "city": "BRISTOL",
            "state": "TN",
            "postal_code": "376207349",
            "telephone_number": "423-990-2414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOCCAROSSA",
        "first_name": "SUSAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-09",
        "last_updated": "2008-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "MD 29434",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5830508",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joanne Blow, M.D.
• Blue Ridge Medical Management Corpoartion
• Blue Ridge Medical Specialists PC
• Blue Ridge Radiology, P.C.
• Travis Boaz, M.D.
• Brandon Coy Bogle, PHD
• Ali Abid Bokhari, M.D.
• Charles Bolick, MD
• Tracy Boling, LPC
• Linda Rhea Bolt

• Internal Medicine Physician in Bristol, TN
• Providers in Bristol, TN by specialty
• Internal Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.