MEDICARE: DR. KAREN ELIZABETH OLDHAM PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	2720	NC

General Provider Information

NPI Number	:	1235216821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAREN ELIZABETH OLDHAM PSY.D.

Provider Business Mailing Address
First Line	:	1905 J N PEASE PL
Second Line	:	SUITE 104
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-4557
Country	:	US
Telephone Number	:	704-549-0333
Fax Number	:	704-549-0333

Provider Business Practice Location Address
First Line	:	1905 J N PEASE PL
Second Line	:	SUITE 104
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-4557
Country	:	US
Telephone Number	:	704-549-0333
Fax Number	:	704-549-0333

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/08/2007

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