Provider Demographics
NPI:1558359083
Name:HERSHEY, CHARLES DANA (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:DANA
Last Name:HERSHEY
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 36351
Mailing Address - Street 2:SOUTHEAST ANESTHESIOLOGY CONSULTANTS PA
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28236-6351
Mailing Address - Country:US
Mailing Address - Phone:704-377-5772
Mailing Address - Fax:704-377-3389
Practice Address - Street 1:1000 BLYTHE BLVD
Practice Address - Street 2:SOUTHEAST ANESTHESIOLOGY CONSULTANTS PA
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5812
Practice Address - Country:US
Practice Address - Phone:704-355-2372
Practice Address - Fax:704-355-6692
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC20606207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8941994Medicaid
SC208158OtherMEDICAID
NC207232AMedicare ID - Type Unspecified
NC8941994Medicaid