MEDICARE: CHARLES WILLIAM HARTNETT

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	171000000X	Military Health Care Provider

General Provider Information

NPI Number	:	1104510866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES WILLIAM HARTNETT

Provider Business Mailing Address
First Line	:	1240 E 9TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44199-9904
Country	:	US
Telephone Number	:	216-902-6260
Fax Number	:	216-902-6197

Provider Business Practice Location Address
First Line	:	1240 E 9TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44199-9904
Country	:	US
Telephone Number	:	216-902-6260
Fax Number	:	216-902-6197

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

Provider Enumeration Date	:	06/06/2023
Last Update Date	:	06/06/2023

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Directions to “ CHARLES WILLIAM HARTNETT ” Practice Location

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