Healthcare Provider Details

I. General information

NPI: 1386706323
Provider Name (Legal Business Name): CHARITY C TUMANGDAY M. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 07/11/2022
Certification Date: 07/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE
CLEVELAND OH
44195-3001
US

IV. Provider business mailing address

1439 RIVERSIDE RD
NILES MI
49120-9057
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-4383
  • Fax:
Mailing address:
  • Phone: 269-932-2412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number35145162
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number002792
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: