Provider Demographics
NPI:1407837123
Name:MACHEN, CHARLES WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:WILLIAM
Last Name:MACHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 S PETERS RD
Mailing Address - Street 2:STE. 105
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-5207
Mailing Address - Country:US
Mailing Address - Phone:865-470-8844
Mailing Address - Fax:865-539-0956
Practice Address - Street 1:224 S PETERS RD
Practice Address - Street 2:STE. 105
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-5207
Practice Address - Country:US
Practice Address - Phone:865-470-8844
Practice Address - Fax:865-539-0956
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000027281208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
F77035Medicare UPIN