MEDICARE: DOUGLAS WAYNE HARLEY DO

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	34008403	OH

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3600271	OTHER	OH	CFM MEDICARE GROUP #
5	9338635	OTHER	OH	PARTNERS PHYSICIAN GROUP MEDICARE GROUP #
7	4177252	OTHER	OH	MEDICARE PTAN (PPG)
10	7402171	OTHER	OH	MEDICARE PTAN (CFM)

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1548207111	OTHER	OH	CFG TYPE 2 NPI #
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	1821035940	OTHER	OH	AGMC (CFM)TYPE 2 NPI #
8	1841239274	OTHER	OH	PARTNERS PHYSICIAN GROUP TYPE 2 NPI #
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1376530519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS WAYNE HARLEY DO

Provider Business Mailing Address
First Line	:	676 SOUTH BROADWAY STREET
Second Line	:	CANAL PHYSICIANS GROUP
City	:	AKRON
State	:	OH
Zip	:	44311-1059
Country	:	US
Telephone Number	:	330-344-4000
Fax Number	:	330-253-2349

Provider Business Practice Location Address
First Line	:	676 SOUTH BROADWAY STREET
Second Line	:	CANAL PHYSICIANS GROUP
City	:	AKRON
State	:	OH
Zip	:	44311-1059
Country	:	US
Telephone Number	:	330-344-4000
Fax Number	:	330-253-2349

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

Provider Enumeration Date	:	10/03/2005
Last Update Date	:	01/24/2013

676 S BROADWAY ST , SUITE 102
AKRON, OH
44311-1059

Practice Phone: 330-344-4005
Practice Fax: 330-344-0005