Provider Demographics
NPI:1083628705
Name:HORNADAY, CHARLES E JR (MD)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:E
Last Name:HORNADAY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4000 KRESGE WAY
Mailing Address - Street 2:STE 100
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207
Mailing Address - Country:US
Mailing Address - Phone:508-897-1121
Mailing Address - Fax:502-897-1189
Practice Address - Street 1:4000 KRESGE WAY
Practice Address - Street 2:STE 100
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207
Practice Address - Country:US
Practice Address - Phone:508-897-1121
Practice Address - Fax:502-897-1189
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY22650207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64226509Medicaid
110174167OtherRR MCARE
KY000000051873OtherANTHEM
KY000000051873OtherANTHEM
KY000000051873OtherANTHEM
KY0523104Medicare ID - Type Unspecified