MEDICARE: DR. CHARLES Y HACHEM MD

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	207Q00000X	Family Medicine Physician	0101235736	VA

General Provider Information

NPI Number	:	1841203759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES Y HACHEM MD

Provider Business Mailing Address
First Line	:	1651 ROCK PRAIRIE RD
Second Line	:	SUITE 100
City	:	COLLEGE STATION
State	:	TX
Zip	:	77845-8652
Country	:	US
Telephone Number	:	979-680-0361
Fax Number	:

Provider Business Practice Location Address
First Line	:	1651 ROCK PRAIRIE RD
Second Line	:	SUITE 100
City	:	COLLEGE STATION
State	:	TX
Zip	:	77845-8652
Country	:	US
Telephone Number	:	979-680-0361
Fax Number	:

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

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	09/23/2009

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