MEDICARE: CHARLES YENWEI PENG M.D.

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	261875	NY
2	207RP1001X	Pulmonary Disease Physician	35-126941	OH

General Provider Information

NPI Number	:	1326200387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES YENWEI PENG M.D.

Provider Business Mailing Address
First Line	:	20800 HARVARD RD
Second Line	:	2ND FLR
City	:	HIGHLAND HILLS
State	:	OH
Zip	:	44122-7251
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13221 RAVENNA RD STE 3
Second Line	:
City	:	CHARDON
State	:	OH
Zip	:	44024-9016
Country	:	US
Telephone Number	:	440-214-3114
Fax Number	:

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

Provider Enumeration Date	:	06/30/2008
Last Update Date	:	12/31/2020

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Directions to “ CHARLES YENWEI PENG M.D.” Practice Location

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