Provider Demographics
NPI:1881720886
Name:MBANEFO, CHARLES (MD MRCP)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
Last Name:MBANEFO
Suffix:
Gender:M
Credentials:MD MRCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11201 SHAKER BLVD SUITE 130
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44104-3833
Mailing Address - Country:US
Mailing Address - Phone:216-368-5687
Mailing Address - Fax:
Practice Address - Street 1:11201 SHAKER BLVD SUITE 130
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44104-3833
Practice Address - Country:US
Practice Address - Phone:216-368-5687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35051577M207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology