Healthcare Provider Details

I. General information

NPI: 1205649811
Provider Name (Legal Business Name): HADLEY MEDICINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2025
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 W FRANKLIN ST
DAYTON OH
45459-4738
US

IV. Provider business mailing address

PO BOX 751381
DAYTON OH
45475-1381
US

V. Phone/Fax

Practice location:
  • Phone: 909-647-8554
  • Fax:
Mailing address:
  • Phone: 909-647-8554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2088F0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Urology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID A HADLEY
Title or Position: OWNER
Credential: MD
Phone: 909-647-8554