Healthcare Provider Details

I. General information

NPI: 1669316147
Provider Name (Legal Business Name): CHRIS MAMONE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6774 GATES MILLS BLVD
GATES MILLS OH
44040-9305
US

IV. Provider business mailing address

6774 GATES MILLS BLVD
GATES MILLS OH
44040-9305
US

V. Phone/Fax

Practice location:
  • Phone: 216-973-6471
  • Fax:
Mailing address:
  • Phone: 216-973-6471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number57.260437
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: