MEDICARE: CHARYL OVALLE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD470978	PA

General Provider Information

NPI Number	:	1245763713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARYL OVALLE M.D.

Provider Business Mailing Address
First Line	:	7439 FRANKFORD AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19136-3600
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7439 FRANKFORD AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19136-3600
Country	:	US
Telephone Number	:	215-333-9484
Fax Number	:	215-333-7739

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2017
Last Update Date	:	09/25/2023

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