Provider Demographics
NPI:1144379538
Name:CHARLES E. HULL, M.D., INC.
Entity Type:Organization
Organization Name:CHARLES E. HULL, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:HULL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-332-4648
Mailing Address - Street 1:1916 GLEN SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-3293
Mailing Address - Country:US
Mailing Address - Phone:419-332-4648
Mailing Address - Fax:419-332-9099
Practice Address - Street 1:1916 GLEN SPRINGS DR
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-3293
Practice Address - Country:US
Practice Address - Phone:419-332-4648
Practice Address - Fax:419-332-9099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH27964207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0120023Medicaid
OH0120023Medicaid
OHHU0874561Medicare ID - Type Unspecified