Provider Demographics
NPI:1295817591
Name:PO, DIVINA T (MD06)
Entity Type:Individual
Prefix:DR
First Name:DIVINA
Middle Name:T
Last Name:PO
Suffix:
Gender:F
Credentials:MD06
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3443 DICKERSON PIKE STE 260
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37207-2534
Mailing Address - Country:US
Mailing Address - Phone:615-868-0323
Mailing Address - Fax:
Practice Address - Street 1:3443 DICKERSON PIKE STE 260
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37207-2534
Practice Address - Country:US
Practice Address - Phone:615-868-0323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD 8180207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN000826OtherBLUE CROSS BLUE SHIELD
TN3160659Medicare ID - Type Unspecified
TNB59278Medicare UPIN