Healthcare Provider Details

I. General information

NPI: 1740819911
Provider Name (Legal Business Name): CHARLES W HURT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 04/08/2020
Certification Date: 04/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 RIVERBEND DR STE 1
CHARLOTTESVILLE VA
22911-8708
US

IV. Provider business mailing address

PO BOX 8147
CHARLOTTESVILLE VA
22906-8147
US

V. Phone/Fax

Practice location:
  • Phone: 434-979-8181
  • Fax: 434-296-3510
Mailing address:
  • Phone: 434-979-8181
  • Fax: 434-296-3510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101012308
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: