Healthcare Provider Details

I. General information

NPI: 1083797542
Provider Name (Legal Business Name): CHARLES JOSEPH VACANTI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 FLETCHER RD
PITTSFORD NY
14534-2909
US

IV. Provider business mailing address

19 FLETCHER RD
PITTSFORD NY
14534-2909
US

V. Phone/Fax

Practice location:
  • Phone: 585-381-7331
  • Fax:
Mailing address:
  • Phone: 585-381-7331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number091008
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number091008
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: