Provider Demographics
NPI:1225223043
Name:HADLEY, DAVID A (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:HADLEY
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 1:3737 SOUTHERN BLVD STE 4200
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-0135
Mailing Address - Country:US
Mailing Address - Phone:937-294-1489
Mailing Address - Fax:937-297-6468
Practice Address - Street 1:3737 SOUTHERN BLVD STE 4200
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-0135
Practice Address - Country:US
Practice Address - Phone:937-294-1489
Practice Address - Fax:937-297-6468
Is Sole Proprietor?:No
Enumeration Date:2007-09-14
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-12740208800000X, 2088F0040X
OH35.1344232088F0040X
OH353134423208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No2088F0040XAllopathic & Osteopathic PhysiciansUrologyFemale Pelvic Medicine and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0305503Medicaid
CO69707740Medicaid
ID1225223043Medicaid