Provider Demographics
NPI:1861490625
Name:CARDONE, CHARLES CHRISTOPHER (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:CHRISTOPHER
Last Name:CARDONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3789 COUNTRY CLUB PL
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45208-1905
Mailing Address - Country:US
Mailing Address - Phone:513-321-2060
Mailing Address - Fax:886-425-6072
Practice Address - Street 1:3789 COUNTRY CLUB PL
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45208-1905
Practice Address - Country:US
Practice Address - Phone:513-321-2060
Practice Address - Fax:886-425-6072
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35060780207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0941173Medicaid
OH0941173Medicaid