Individual
DIANE L PETRILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2240 SUTHERLAND AVE, SUITE 104, KNOXVILLE, TN 37919-2333
(865) 909-0090
(865) 909-9883
Mailing address
1225 E WEISGARBER RD, SUITE 200, KNOXVILLE, TN 37909-2604
(865) 584-4747
(865) 584-1363
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
017129
TN
207Q00000X
Family Medicine Physician
15138
NH
207Q00000X
Family Medicine Physician
32266
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3373633
MEDICARE GROUP ID
TN
Enumeration date
01/25/2006
Last updated
02/14/2013
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