Provider Demographics
NPI:1457354599
Name:DEFLUMERE, CHARLOTTE A (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLOTTE
Middle Name:A
Last Name:DEFLUMERE
Suffix:
Gender:F
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:PO BOX 17825
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38187-0825
Mailing Address - Country:US
Mailing Address - Phone:901-405-6470
Mailing Address - Fax:901-747-2338
Practice Address - Street 1:1068 CRESTHAVEN RD
Practice Address - Street 2:SUITE 110
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-0800
Practice Address - Country:US
Practice Address - Phone:901-405-6470
Practice Address - Fax:901-747-2338
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2012-09-11
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-21
Provider Licenses
StateLicense IDTaxonomies
TNMD0000020004207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4417762OtherAETNA
TN5007925Medicaid
TN627127667OtherTAX ID
TN3106698OtherTN BCBS PROVIDER NUMBER
TN110214654OtherRAILROAD MEDICARE
TN3826001Medicaid
TN627127667OtherTAX ID
TN3826001Medicare ID - Type UnspecifiedTN MEDICARE