Healthcare Provider Details

I. General information

NPI: 1639140585
Provider Name (Legal Business Name): KAREN L OLDHAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KAREN L VANBUREN MD

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 10/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2395 CEDAR GROVE RD
LEBANON TN
37087-7991
US

IV. Provider business mailing address

2395 CEDAR GROVE RD
LEBANON TN
37087-7991
US

V. Phone/Fax

Practice location:
  • Phone: 615-444-4126
  • Fax:
Mailing address:
  • Phone: 615-444-4126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number019052
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number019052
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number19052
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: