Basic Information
| Provider Information | |||||||||
| NPI: | 1669429502 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HEARN | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | |||||||||
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| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 80690 | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 447080690 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303637444 | ||||||||
| FaxNumber: | 3303637770 | ||||||||
| Practice Location | |||||||||
| Address1: | 2600 SIXTH STREET SW | ||||||||
| Address2: | OHIO HOSPITAL BASED PHYSICIAN CORP | ||||||||
| City: | CANTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303637462 | ||||||||
| FaxNumber: | 3303637679 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2006 | ||||||||
| LastUpdateDate: | 07/05/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 34004519 | OH | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 0782210 | 05 | OH | MEDICAID |