MEDICARE: CHARLES DOUGLAS HENSLEY MD

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	207N00000X	Dermatology Physician	28377	KY
2	207NS0135X	Procedural Dermatology Physician	28377	KY

General Provider Information

NPI Number	:	1124025994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES DOUGLAS HENSLEY MD

Provider Business Mailing Address
First Line	:	305B MIDDLETOWN PARK PL
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40243-2514
Country	:	US
Telephone Number	:	502-254-2300
Fax Number	:	502-254-7087

Provider Business Practice Location Address
First Line	:	305B MIDDLETOWN PARK PL STE B
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40243-2514
Country	:	US
Telephone Number	:	502-254-2300
Fax Number	:	502-254-7087

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	02/03/2023

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