Basic Information
| Provider Information | |||||||||
| NPI: | 1003044033 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BENSON | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | DANIEL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 90 VERMONT AVE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | OAK RIDGE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378306474 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8654829025 | ||||||||
| FaxNumber: | 8654838151 | ||||||||
| Practice Location | |||||||||
| Address1: | 90 VERMONT AVE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | OAK RIDGE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378306474 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8654829025 | ||||||||
| FaxNumber: | 8654838151 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2009 | ||||||||
| LastUpdateDate: | 06/14/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 51371 | TN | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | Q007795 | 05 | TN | MEDICAID | P01460328 | 01 | TN | MEDICARE RAILROAD | OTHER | 2249733 | 01 | TN | CIGNA | OTHER | 6024967 | 01 | TN | BLUECROSS BLUESHIELD | OTHER |