Provider Demographics
NPI:1669471512
Name:SCHROEDER, CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:SCHROEDER
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 1:9330 PARK WEST BLVD
Mailing Address - Street 2:STE 502
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923
Mailing Address - Country:US
Mailing Address - Phone:865-531-3303
Mailing Address - Fax:865-531-1272
Practice Address - Street 1:9330 PARK WEST BLVD
Practice Address - Street 2:STE 502
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923
Practice Address - Country:US
Practice Address - Phone:865-531-3303
Practice Address - Fax:865-531-1272
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN28382207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
4063853OtherBLUE CARE - TNCARE
5504519OtherAETNA
3720237OtherGRP MEDICARE
SC3804619OtherMEDICAID CLAIMS RECIEPT
4063853OtherBCBS
TN3804619Medicaid
SC3720237OtherGRP MEDICAID CLAIMS RECIE
3720237OtherGRP MEDICAID
TN0101OtherJOHN DEERE
4063853OtherBCBS
3804619Medicare ID - Type Unspecified