Provider Demographics
NPI:1427233055
Name:INGENERI, TREVOR J (MD)
Entity Type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:J
Last Name:INGENERI
Suffix:
Gender:M
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:PO BOX 59002
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37950-9002
Mailing Address - Country:US
Mailing Address - Phone:865-588-5121
Mailing Address - Fax:865-588-5126
Practice Address - Street 1:629 DELOZIER WAY
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:TN
Practice Address - Zip Code:37849-4030
Practice Address - Country:US
Practice Address - Phone:865-588-5121
Practice Address - Fax:865-588-5126
Is Sole Proprietor?:No
Enumeration Date:2008-01-02
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD43154207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ008671Medicaid
TNQ008671Medicaid