Provider Demographics
NPI:1871599084
Name:BORRELLI, GERALD SCOTT (MD)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:SCOTT
Last Name:BORRELLI
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 1:2001 LAUREL AVE
Mailing Address - Street 2:STE 206
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-1865
Mailing Address - Country:US
Mailing Address - Phone:865-524-3131
Mailing Address - Fax:865-212-6323
Practice Address - Street 1:2001 LAUREL AVE
Practice Address - Street 2:STE 206
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-1865
Practice Address - Country:US
Practice Address - Phone:865-524-3131
Practice Address - Fax:865-212-6323
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD31245207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN390007330OtherRAILROAD MEDICARE
TN602002329OtherCARITEN HEALTHCARE
TN3158711OtherBLUE CROSS
TN3843024Medicaid
TN4405986OtherAETNA US HEALTHCARE
TN3158711OtherBLUE CROSS
TN602002329OtherCARITEN HEALTHCARE