Provider Demographics
NPI:1972513406
Name:FUENNING, CHARLES R (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:R
Last Name:FUENNING
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 1:95 ARCH ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1437
Mailing Address - Country:US
Mailing Address - Phone:330-253-1411
Mailing Address - Fax:330-253-1720
Practice Address - Street 1:1900 23RD ST STE 1200
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-1404
Practice Address - Country:US
Practice Address - Phone:330-253-1411
Practice Address - Fax:330-253-1720
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35049226207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0622973Medicaid
P01012873Medicare PIN
H017800Medicare PIN
A15442Medicare UPIN