Provider Demographics
NPI:1063692341
Name:CHARLES D HANSHAW DO INC
Entity type:Organization
Organization Name:CHARLES D HANSHAW DO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:D
Authorized Official - Last Name:HANSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:937-439-7430
Mailing Address - Street 1:8940 KINGSRIDGE DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45458-1632
Mailing Address - Country:US
Mailing Address - Phone:937-439-7430
Mailing Address - Fax:937-439-7446
Practice Address - Street 1:8940 KINGSRIDGE DR
Practice Address - Street 2:SUITE 103
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45458-1632
Practice Address - Country:US
Practice Address - Phone:937-439-7430
Practice Address - Fax:937-439-7446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH009141207Q00000X
OH34003234H207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0734245Medicaid
OH0734245Medicaid
OH9309701Medicare PIN