Provider Demographics
NPI:1851712038
Name:HAHN, CHARLES RAYMOND (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:RAYMOND
Last Name:HAHN
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 1:187 SW EASTMAN PKWY
Mailing Address - Street 2:STE. #72
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-7002
Mailing Address - Country:US
Mailing Address - Phone:503-307-1363
Mailing Address - Fax:
Practice Address - Street 1:187 SW EASTMAN PKWY
Practice Address - Street 2:STE. #72
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97080-7002
Practice Address - Country:US
Practice Address - Phone:503-307-1363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-14
Last Update Date:2013-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD08295207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology