MEDICARE: CHARLES D HANSHAW DO INC

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	207Q00000X	Family Medicine Physician	009141	OH
2	207R00000X	Internal Medicine Physician	34003234H	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063692341
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLES D HANSHAW DO INC

Provider Business Mailing Address
First Line	:	8940 KINGSRIDGE DR
Second Line	:	SUITE 103
City	:	DAYTON
State	:	OH
Zip	:	45458-1632
Country	:	US
Telephone Number	:	937-439-7430
Fax Number	:	937-439-7446

Provider Business Practice Location Address
First Line	:	8940 KINGSRIDGE DR
Second Line	:	SUITE 103
City	:	DAYTON
State	:	OH
Zip	:	45458-1632
Country	:	US
Telephone Number	:	937-439-7430
Fax Number	:	937-439-7446

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CHARLES D HANSHAW
Credential	:	DO
Telephone Number	:	937-439-7430

Provider Enumeration Date	:	11/05/2007
Last Update Date	:	06/30/2009

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