Provider Demographics
NPI:1104874106
Name:CHARI, VEDANTUM (MD)
Entity type:Individual
Prefix:DR
First Name:VEDANTUM
Middle Name:
Last Name:CHARI
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 1:275 SPRINGSIDE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44333-4549
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13951 TERRACE RD
Practice Address - Street 2:
Practice Address - City:EAST CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-4308
Practice Address - Country:US
Practice Address - Phone:216-761-4223
Practice Address - Fax:216-761-3499
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-044127174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0458795Medicaid
OH0458795Medicaid
OH0485285Medicare PIN