Provider Demographics
NPI:1346001401
Name:MCGREGOR, CHARESE
Entity Type:Individual
Prefix:
First Name:CHARESE
Middle Name:
Last Name:MCGREGOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SEVERANCE CIR STE 503
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-1588
Mailing Address - Country:US
Mailing Address - Phone:216-956-1927
Mailing Address - Fax:
Practice Address - Street 1:5 SEVERANCE CIR STE 503
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-1588
Practice Address - Country:US
Practice Address - Phone:216-956-1927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver