Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 61180 | TN |
Y | 207RI0011X | Interventional Cardiology | 61180 | TN |
NPI | 1104262096 |
---|---|
Provider Name | Dr. Charles Joseph Allderdice |
First Address | Knoxville, TN 37920 |
Second Address | Knoxville, TN 37923-4301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2013 |
Last Update Date | 14/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q058411 | (05) | TN |