Provider Demographics
NPI:1639140585
Name:OLDHAM, KAREN L (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:L
Last Name:OLDHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:L
Other - Last Name:VANBUREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2395 CEDAR GROVE RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-7991
Mailing Address - Country:US
Mailing Address - Phone:615-444-4126
Mailing Address - Fax:
Practice Address - Street 1:2395 CEDAR GROVE RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-7991
Practice Address - Country:US
Practice Address - Phone:615-444-4126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0190522083X0100X, 208D00000X
TN19052207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
4510052OtherAETNA
351808200OtherDOL FECA W/COMP (OWCP)
TN3704080OtherMEDICARE GROUP
P00425475OtherRAILROAD MEDICARE PGBA
TN3870738Medicaid
TN4145836OtherBCBS
351808200OtherDOL FECA W/COMP (OWCP)
TN30341201Medicare PIN
3870738Medicare PIN