Individual
KAREN L OLDHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2395 CEDAR GROVE RD, LEBANON, TN 37087-7991
(615) 444-4126
Mailing address
2395 CEDAR GROVE RD, LEBANON, TN 37087-7991
(615) 444-4126
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
19052
TN
2083X0100X
Occupational Medicine Physician
019052
TN
208D00000X
General Practice Physician
019052
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
351808200
DOL FECA W/COMP (OWCP)
—
01
—
3704080
MEDICARE GROUP
TN
05
—
3870738
—
TN
01
—
4145836
BCBS
TN
01
—
4510052
AETNA
—
01
—
P00425475
RAILROAD MEDICARE PGBA
—
Enumeration date
01/30/2006
Last updated
10/07/2015
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