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General NPI Number Information
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NPI Number | 1831178003
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Entity Type | Individual
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Provider Name | CHARLES DAVID O'SHAUGHNESSY M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/16/2006
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Last Update Date | 01/07/2021
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Provider Practice Location Address
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Address Line | 125 E BROAD ST SUITE 305
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City | ELYRIA
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State | OH
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Zip | 44035-6400
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Country | US
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Telephone | 440-414-9100
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Fax | 216-201-5578
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Provider Business Mailing Address
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Address Line | 125 E BROAD ST SUITE 305
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City | ELYRIA
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State | OH
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Zip | 44035-6400
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Country | US
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Telephone | 440-414-9100
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Fax | 216-201-5577
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 35040861
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | 35040861
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License Number State | OH
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