Provider Demographics
NPI:1447247978
Name:HARDIN, CHARLES EDWARD JR (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:EDWARD
Last Name:HARDIN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 88
Mailing Address - Street 2:
Mailing Address - City:SALYERSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41465-0088
Mailing Address - Country:US
Mailing Address - Phone:606-791-1968
Mailing Address - Fax:606-349-1909
Practice Address - Street 1:870 PARKWAY DRIVE
Practice Address - Street 2:HARDIN MEDICAL PLAZA
Practice Address - City:SALYERSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41465-9248
Practice Address - Country:US
Practice Address - Phone:606-791-1968
Practice Address - Fax:606-349-1909
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY22756207QH0002X
KY22765207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64227564Medicaid
KYC74889Medicare UPIN
KY1377603Medicare ID - Type Unspecified