Provider Demographics
NPI:1558448423
Name:WOLOHON, CHARLES T (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:T
Last Name:WOLOHON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1608 WILLIAMS DR.
Mailing Address - Street 2:STE 202
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129
Mailing Address - Country:US
Mailing Address - Phone:615-849-4006
Mailing Address - Fax:615-895-0975
Practice Address - Street 1:1608 WILLIAMS DR.
Practice Address - Street 2:STE 202
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129
Practice Address - Country:US
Practice Address - Phone:615-849-4006
Practice Address - Fax:615-895-0975
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN24804207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TND35421Medicare UPIN
TN3077865Medicare ID - Type Unspecified