Individual
CHARLES S DUVALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AA
Contact information
Practice address
11100 EUCLID AVE, CLEVELAND, OH 44106-1716
(216) 844-7330
Mailing address
3605 WARRENSVILLE CENTER RD, SHAKER HEIGHTS, OH 44122-5203
(216) 286-6260
(216) 286-6341
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
67-000109
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000232162
UNISON
OH
01
—
000000515964
ANTHEM
OH
01
—
0583328
BCMH
OH
05
—
2539917
—
OH
01
—
414965
WELLCARE MEDICAID
OH
01
—
7733967
AETNA
OH
01
—
P00444996
RAILROAD MEDICARE
OH
Enumeration date
07/24/2006
Last updated
05/12/2008
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