Provider Demographics
NPI:1477547289
Name:HEDGES, CHARLES RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:RICHARD
Last Name:HEDGES
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 1:583 HICKORY PL
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43113-1123
Mailing Address - Country:US
Mailing Address - Phone:740-474-5464
Mailing Address - Fax:
Practice Address - Street 1:583 HICKORY PL
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-1123
Practice Address - Country:US
Practice Address - Phone:740-474-5464
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35 030366207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0580983Medicaid
OH0580983Medicaid
0395702Medicare ID - Type Unspecified