Provider Demographics
NPI:1477623940
Name:HADEN, CHARLES B (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:B
Last Name:HADEN
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:PO BOX 87
Mailing Address - Street 2:
Mailing Address - City:HADENSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23067-0087
Mailing Address - Country:US
Mailing Address - Phone:804-273-0010
Mailing Address - Fax:804-273-0049
Practice Address - Street 1:5310 TWIN HICKORY RD
Practice Address - Street 2:SUITE A
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-5783
Practice Address - Country:US
Practice Address - Phone:804-273-0010
Practice Address - Fax:804-273-0049
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101035751207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA080001681OtherMEDICARE OTHER PROVIDER
VA0101035751OtherSTATE LICENSE
VA010375355Medicaid
VA5290269OtherAETNA NON HMO
VA1538518OtherAETNA HMO
VA633556OtherAETNA CAP
VACO2375OtherMEDICARE GROUP
VA298282OtherANTHEM TM
VACA9037OtherMCR RAILROAD GROUP
VA2163415OtherMAMSI
VA080001681OtherMEDICARE OTHER PROVIDER
VAP00383968Medicare PIN
VA013124P75Medicare PIN