Provider Demographics
NPI:1114238458
Name:VENDITTI, CHARIS A (MD)
Entity type:Individual
Prefix:
First Name:CHARIS
Middle Name:A
Last Name:VENDITTI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 MYRTLE ST STE 290
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-4609
Mailing Address - Country:US
Mailing Address - Phone:814-879-6636
Mailing Address - Fax:814-452-5015
Practice Address - Street 1:2315 MYRTLE ST STE 290
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-4609
Practice Address - Country:US
Practice Address - Phone:814-879-6636
Practice Address - Fax:814-452-5015
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4521852086X0206X, 207V00000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
13682717OtherCAQH
PA103092359Medicaid