Provider Demographics
NPI:1497849707
Name:PIERCE, CHARLES HARMON (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:HARMON
Last Name:PIERCE
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5563 REGIMENTAL PL
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45239-6718
Mailing Address - Country:US
Mailing Address - Phone:513-681-4084
Mailing Address - Fax:513-681-4094
Practice Address - Street 1:3802 PAXTON AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45209-2399
Practice Address - Country:US
Practice Address - Phone:513-559-9700
Practice Address - Fax:513-559-0900
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.082173207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2488222Medicaid
OHC62227Medicare UPIN