Healthcare Provider Details

I. General information

NPI: 1184914285
Provider Name (Legal Business Name): TERENCE BRETT KOTHE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2011
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 ALCOA HWY STE 145
KNOXVILLE TN
37921
US

IV. Provider business mailing address

1930 ALCOA HWY STE 145
KNOXVILLE TN
37921
US

V. Phone/Fax

Practice location:
  • Phone: 865-582-3111
  • Fax:
Mailing address:
  • Phone: 865-305-9749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number57409
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number57409
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: