Provider Demographics
NPI:1841678083
Name:RUNGE, CHASTITY (DO)
Entity type:Individual
Prefix:
First Name:CHASTITY
Middle Name:
Last Name:RUNGE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 BURDSALL AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MITCHELL
Mailing Address - State:KY
Mailing Address - Zip Code:41017-2823
Mailing Address - Country:US
Mailing Address - Phone:859-916-1736
Mailing Address - Fax:
Practice Address - Street 1:405 W GRAND AVE
Practice Address - Street 2:MEDICAL EDUCATION DEPARTMENT
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-4720
Practice Address - Country:US
Practice Address - Phone:937-723-3245
Practice Address - Fax:937-723-5016
Is Sole Proprietor?:No
Enumeration Date:2015-05-07
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.013166208M00000X
OH390200000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine