Provider Demographics
NPI:1770536336
Name:WECKESSER, DONALD 'CHARLES' NED (MD)
Entity type:Individual
Prefix:DR
First Name:DONALD 'CHARLES'
Middle Name:NED
Last Name:WECKESSER
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 1:215 FORKS OF THE RIVER PKWY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37862-3410
Mailing Address - Country:US
Mailing Address - Phone:865-908-2838
Mailing Address - Fax:865-908-6179
Practice Address - Street 1:215 FORKS OF THE RIVER PKWY
Practice Address - Street 2:SUITE 2
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-3410
Practice Address - Country:US
Practice Address - Phone:865-908-2838
Practice Address - Fax:865-908-6179
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000028080174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNG28846Medicare UPIN