1316937568 NPI number — DR. CHARLES P HADDAD OD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316937568 NPI number — DR. CHARLES P HADDAD OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HADDAD
Provider First Name:
CHARLES
Provider Middle Name:
P
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316937568
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 489
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOMERVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38068-0489
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-465-3955
Provider Business Mailing Address Fax Number:
901-465-6797

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 E MARKET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOMERVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38068-1407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-465-3955
Provider Business Practice Location Address Fax Number:
901-465-6797
Provider Enumeration Date:
10/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  T377 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 47519 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 13963 . This is a "TLC MEMPHIS MANAGED CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2240072 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 47519 . This is a "TN CARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 5843 . This is a "OMNI" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 410026537 . This is a "RAIL ROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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