Healthcare Provider Details

I. General information

NPI: 1669429502
Provider Name (Legal Business Name): CHARLES HEARN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 07/05/2022
Certification Date: 07/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 SIXTH STREET SW OHIO HOSPITAL BASED PHYSICIAN CORP
CANTON OH
44710
US

IV. Provider business mailing address

PO BOX 80690
CANTON OH
44708-0690
US

V. Phone/Fax

Practice location:
  • Phone: 330-363-7462
  • Fax: 330-363-7679
Mailing address:
  • Phone: 330-363-7444
  • Fax: 330-363-7770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number34004519
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: