Provider Demographics
NPI:1538165337
Name:VALONE, CHARLES L JR (DO)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:L
Last Name:VALONE
Suffix:JR
Gender:M
Credentials:DO
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Mailing Address - Street 1:1223 OAK HARBOR RD
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-1020
Mailing Address - Country:US
Mailing Address - Phone:419-334-7191
Mailing Address - Fax:419-334-7405
Practice Address - Street 1:1223 OAK HARBOR RD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-1020
Practice Address - Country:US
Practice Address - Phone:419-334-7191
Practice Address - Fax:419-334-7405
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH3421OH207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3421OHOtherSTATE LICENSE
OH0500372Medicaid
OH0500372Medicaid