Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Vitaly Gennadievich Nazarov, MD

Individual provider Hospitalist Physician · NPI 1760469084

Dr. Vitaly Gennadievich Nazarov, MD is an Internal Medicine in Kingsport, Tennessee. Qualified in 1989, 37 years ago. Practices with Self Medical Group, a 396-clinician group and accepts Medicare assignment. Licensed in Missouri, Tennessee and Virginia.

Years since qualifying
37
Licensed in
MO, TN, VA
In the registry since
2005
Specialties on file
3
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

130 W Ravine Rd
Kingsport, TN 37660-3837
Phone: (423) 224-3628
Fax: (423) 230-8502
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Internal Medicine Physician (primary) Taxonomy 207R00000X · Licence 2017038349 (MO)
Hospitalist Physician Taxonomy 208M00000X · Licence 0101254975 (VA)
Hospitalist Physician Taxonomy 208M00000X · Licence 40147 (TN)

Record details

NPI number1760469084
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedDecember 28, 2005
Last updated in NPPESNovember 21, 2025
Certification dateNovember 21, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyINTERNAL MEDICINE
Medical schoolOTHER
Graduated 1989 (37 years in practice)
Group practice Self Medical Group — 396 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

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