MEDICARE: DR. CHARLES L VALONE JR. D.O.

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	207R00000X	Internal Medicine Physician	3421OH	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3421OH	OTHER	OH	STATE LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538165337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES L VALONE JR. D.O.

Provider Business Mailing Address
First Line	:	1223 OAK HARBOR RD
Second Line	:
City	:	FREMONT
State	:	OH
Zip	:	43420-1020
Country	:	US
Telephone Number	:	419-334-7191
Fax Number	:	419-334-7405

Provider Business Practice Location Address
First Line	:	1223 OAK HARBOR RD
Second Line	:
City	:	FREMONT
State	:	OH
Zip	:	43420-1020
Country	:	US
Telephone Number	:	419-334-7191
Fax Number	:	419-334-7405

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

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	07/08/2007

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