Petrilla, Diane L

Petrilla, Diane L is an individual health care provider with primary practice located at 2240 Sutherland Ave Suite 104, Knoxville TN 37919-2333. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Petrilla, Diane L can be contacted via phone (865) 909-0090.

Contact Information

Primary practice address
2240 Sutherland Ave Suite 104 Knoxville TN 37919-2333
Phone: (865) 909-0090
Fax: (865) 909-9883
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 017129 Tennessee
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 32266 South Carolina
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 15138 New Hampshire

Profile Details

NPI number 1114997830
LBN Legal business name Petrilla, Diane L
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 25th, 2006
Last updated Feb 14th, 2013 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1114997830 NPPES
Tennessee Other 3373633 MEDICARE GROUP ID

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