Individual
DR. CHARLES DAVID O'SHAUGHNESSY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
125 E BROAD ST, SUITE 305, ELYRIA, OH 44035-6400
(440) 414-9100
(216) 201-5578
Mailing address
125 E BROAD ST, SUITE 305, ELYRIA, OH 44035-6400
(440) 414-9100
(216) 201-5577
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
35040861
OH
207RI0011X
Interventional Cardiology Physician
Primary
35040861
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000128711
ANTHEM
OH
05
—
0454244
—
OH
01
—
060013316
RAILROAD MEDICARE
—
01
—
100408
KAISER
OH
01
—
341221800067
CARESOURCE
OH
01
—
E40861
SUMMACARE
OH
Enumeration date
01/16/2006
Last updated
01/07/2021
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