Provider Demographics
NPI:1740224526
Name:SIENKNECHT, CHARLES W (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:W
Last Name:SIENKNECHT
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 1:1035 EXECUTIVE DRIVE
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-7908
Mailing Address - Country:US
Mailing Address - Phone:423-826-0800
Mailing Address - Fax:423-826-0810
Practice Address - Street 1:1035 EXECUTIVE DRIVE
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-7908
Practice Address - Country:US
Practice Address - Phone:423-826-0800
Practice Address - Fax:423-826-0810
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9242207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2001741OtherBLUE CROSS
TN2008308OtherBLUE CROSS GROUP ID
TN2001741OtherBLUE CROSS
TN2008308OtherBLUE CROSS GROUP ID
TNB03448Medicare UPIN