Individual
CHANTAL I DALENCOUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
34960 CENTER RIDGE RD, NORTH RIDGEVILLE, OH 44039-3183
(440) 353-3433
(440) 353-3431
Mailing address
26908 DETROIT RD, SUITE 301, WESTLAKE, OH 44145-2398
(440) 617-1823
(440) 617-0884
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
35073965
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2095021
—
OH
01
—
370017680
RR MEDICARE
OH
Enumeration date
08/11/2005
Last updated
11/17/2020
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