CHARLES O. MBANEFO, MD (NPI# 1356530943) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356530943 |
| Entity Type | Organization |
| Organization Name | CHARLES O. MBANEFO, MD |
| Practice Address |
11201 Shaker Blvd Suite 130 Cleveland OH 44104-3869 |
| Practice Telephone | 2163685687 |
| Practice Fax Number | 2163685623 |
| Mailing Telephone | 2163685687 |
| Mailing Fax Number | 2163685623 |
| Enumeration Date | 2007-10-18 |
| Last Update Date | 2007-10-18 |
| Authorized Official Name | DR. CHARLES O. MBANEFO (OWNER) |
| Authorized Official Telephone | 2163685687 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | 35-05-1577M | OH | Other Service Providers |
| Street Address |
11201 SHAKER BLVD SUITE 130 |
| City | CLEVELAND |
| State | OH |
| Zip Code | 44104-3869 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861495236 | Angela M Bennett | Family Medicine | 11201 Shaker Blvd, Suite 102a, Cleveland, OH 44104 | 2005-05-31 |
| 1659997492 | Jalysa Blake | Case Manager/Care Coordinator | 11201 Shaker Blvd, Cleveland, OH 44104-3869 | 2020-06-17 |
| 1417572348 | Camille Horton | Case Manager/Care Coordinator | 11201 Shaker Blvd, Cleveland, OH 44104-3869 | 2020-06-16 |
| 1073136024 | Carol Range | Case Manager/Care Coordinator | 11201 Shaker Blvd, Cleveland, OH 44104-3869 | 2020-05-26 |
| 1265052179 | Brieana Wilson | Case Manager/Care Coordinator | 11201 Shaker Blvd, Cleveland, OH 44104-3869 | 2020-04-21 |
| 1851802615 | Aditi Parikh | Dentist | 11201 Shaker Blvd, Cleveland, OH 44104-3869 | 2017-10-19 |
| 1932610698 | Quentin Joh-douglas Montgomery | Dentist | 11201 Shaker Blvd, Cleveland, OH 44104 | 2017-10-19 |
| 1972952554 | Cleveland Accident Rehab, LLC | Chiropractor | 11201 Shaker Blvd, 322, Cleveland, OH 44104 | 2016-06-06 |
| 1003276106 | Cleveland Dental Institute LLC | Clinic/Center | 11201 Shaker Blvd, Cleveland, OH 44104-3869 | 2016-03-02 |
| 1336527340 | Lawrence Rossoff | Dentist | 11201 Shaker Blvd, #136, Cleveland, OH 44104-3869 | 2015-05-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619510419 | Gwen Burtin | Technician | 9908 Kennedy Ave, Cleveland, OH 44104 | 2019-10-24 |
| 1215422001 | Julia Shneyderman | Dentist | 11202 Shaker Blvd Ste 136, Cleveland, OH 44104 | 2018-06-25 |
| 1477058527 | Kwananda A Plato | Technician | 9717 Elwell Ave., Cleveland, OH 44104 | 2018-03-29 |
| 1073035887 | Tia Marie Heard | Home Health | 4591 Quincy Avenue Building Q, Cleveland, OH 44104 | 2017-07-13 |
| 1407306608 | Shelby Mcquiller | Social Worker | 2632 E 115th St, Cleveland, OH 44104 | 2016-10-11 |
| 1568852390 | Cleveland Arts & Social Sciences Academy | Psychologist | 10701 Shaker Blvd, Cleveland, OH 44104 | 2015-02-02 |
| 1164827705 | Eboni Danyale Jordan | Licensed Practical Nurse | 3143 East 99th, Cleveland, OH 44104 | 2014-10-24 |
| 1902224157 | Woodland Academy, Inc. | Local Education Agency (LEA) | 10615 Lamontier Blvd., Cleveland, OH 44104 | 2014-04-04 |
| 1467793778 | Teresa M Evans-guyton | Nurse Practitioner | 11201 Shaker Blvd Ste 240, Cleveland, OH 44104 | 2013-03-12 |
| 1023387057 | Roslyn Jeanette Carter | Home Health Aide | 9423 Ramona Blvd, Cleveland, OH 44104 | 2011-12-20 |
| Find all providers in zip 44104 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265896872 | Lindsay Brewster | Specialist | 163 County Road 2298, Cleveland, TX 77327-0118 | 2016-04-09 |
| 1972974855 | Ronald Sherman Coleman | Specialist | 343 Leatha Ln Nw, Cleveland, TN 37312-6444 | 2015-10-17 |
| 1457740961 | Carol Reaves | Specialist | 1113 East 141, St., Cleveland, OH 44110-3685 | 2015-01-21 |
| 1891118378 | Todd Karp | Specialist | 21855 Eaton Rd, Cleveland, OH 44126-2311 | 2014-02-04 |
| 1619226180 | Thomas M Lott Sr. | Specialist | 2486 Adair Mill Rd, Cleveland, GA 30528-3322 | 2012-08-30 |
| 1760712517 | Patrick Alton Gladding | Specialist | 2409 Lee Rd, Cleveland Heights, Cleveland, OH 44118-4124 | 2009-12-29 |
| 1477795227 | Linda Dorsey | Specialist | 2538 Keith St Nw Ste 8, Cleveland, TN 37312-3738 | 2009-03-25 |
| 1598906117 | John Robert Fowler Jr. | Specialist | Emergency Services Institute E 19, 9500 Euclid Avenue, Cleveland, OH 44195-0001 | 2009-03-11 |
| 1275772931 | Raed Nabil Bou Matar | Specialist | 2801 Mlk Jr Dr, Cleveland, OH 44104-3815 | 2009-02-19 |
| 1447405444 | Ivy Trinell Chambers | Specialist | 3737 E 154th St, Cleveland, OH 44120-4917 | 2008-11-18 |
| Find all providers in CLEVELAND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.