Provider Demographics
NPI:1124025994
Name:HENSLEY, CHARLES DOUGLAS (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:DOUGLAS
Last Name:HENSLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305B MIDDLETOWN PARK PL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-2514
Mailing Address - Country:US
Mailing Address - Phone:502-254-2300
Mailing Address - Fax:502-254-7087
Practice Address - Street 1:305B MIDDLETOWN PARK PL STE B
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-2514
Practice Address - Country:US
Practice Address - Phone:502-254-2300
Practice Address - Fax:502-254-7087
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY28377207N00000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2920Medicare ID - Type Unspecified
KY0292001Medicare PIN
E76172Medicare UPIN