1477623940 NPI number — CHARLES B HADEN MD

Table of content: CHARLES B HADEN MD (NPI 1477623940)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477623940 NPI number — CHARLES B HADEN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HADEN
Provider First Name:
CHARLES
Provider Middle Name:
B
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477623940
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 87
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HADENSVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23067-0087
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-273-0010
Provider Business Mailing Address Fax Number:
804-273-0049

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5310 TWIN HICKORY RD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
GLEN ALLEN
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23059-5783
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-273-0010
Provider Business Practice Location Address Fax Number:
804-273-0049
Provider Enumeration Date:
11/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  0101035751 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 080001681 . This is a "MEDICARE OTHER PROVIDER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 0101035751 . This is a "STATE LICENSE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 010375355 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5290269 . This is a "AETNA NON HMO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1538518 . This is a "AETNA HMO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 633556 . This is a "AETNA CAP" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: CO2375 . This is a "MEDICARE GROUP" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 298282 . This is a "ANTHEM TM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: CA9037 . This is a "MCR RAILROAD GROUP" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 2163415 . This is a "MAMSI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com