Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 021441 | TN |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | 28475 | KY |
NPI | 1750374476 |
---|---|
Provider Name | Charles G Sewall |
First Address | Oak Ridge, TN 37830-6957 |
Second Address | Oak Ridge, TN 37830-6957 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2005 |
Last Update Date | 02/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000252844 | ANTHEM BLUE CROSS (01) | KY |
3028800 | BLUE CROSS BLUE SHIELD (01) | TN |
3059927 | (05) | TN |
4532 | CHA (01) | KY |
4666257 | AETNA (01) | TN |
620897289002 | BLUEGRASS (01) | KY |
62089728903 | UHC RIVER VALLEY (01) | TN |
64799125 | (05) | KY |
C10003 | CUMBERLAND HEALTHCARE (01) | KY |
D42236 | (02) | TN |