Provider Demographics
NPI:1194794933
Name:PRESENTATION, PHILOMINA (MD)
Entity type:Individual
Prefix:DR
First Name:PHILOMINA
Middle Name:
Last Name:PRESENTATION
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 ROCKWELL FARM LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-4461
Mailing Address - Country:US
Mailing Address - Phone:865-386-6614
Mailing Address - Fax:
Practice Address - Street 1:9031 CROSS PARK DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4602
Practice Address - Country:US
Practice Address - Phone:865-545-4592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD345102084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
H66631Medicare UPIN