1457354599 NPI number — DR. CHARLOTTE A DEFLUMERE M.D.

Table of content: DR. CHARLOTTE A DEFLUMERE M.D. (NPI 1457354599)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457354599 NPI number — DR. CHARLOTTE A DEFLUMERE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEFLUMERE
Provider First Name:
CHARLOTTE
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1457354599
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/15/2006
NPI Reactivation Date:
03/21/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 17825
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38187-0825
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-405-6470
Provider Business Mailing Address Fax Number:
901-747-2338

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1068 CRESTHAVEN RD
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38119-0800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-405-6470
Provider Business Practice Location Address Fax Number:
901-747-2338
Provider Enumeration Date:
05/23/2005

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: 207R00000X , with the licence number:  MD0000020004 , 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: 4417762 . This is a "AETNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 5007925 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 627127667 . This is a "TAX ID" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3106698 . This is a "TN BCBS PROVIDER NUMBER" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 110214654 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3826001 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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