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General NPI Number Information
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NPI Number | 1841678083
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Entity Type | Individual
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Provider Name | CHASTITY RUNGE D.O.
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Gender | Female
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Dates
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Enumeration Date | 05/07/2015
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Last Update Date | 03/22/2021
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Provider Practice Location Address
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Address Line | 405 W GRAND AVE MEDICAL EDUCATION DEPARTMENT
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City | DAYTON
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State | OH
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Zip | 45405-4720
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Country | US
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Telephone | 937-723-3245
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Fax | 937-723-5016
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Provider Business Mailing Address
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Address Line | 107 BURDSALL AVE
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City | FORT MITCHELL
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State | KY
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Zip | 41017-2823
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Country | US
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Telephone | 859-916-1736
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Fax |
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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 | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 34.013166
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 390200000
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License Number State | OH
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