Healthcare Provider Details

I. General information

NPI: 1114238458
Provider Name (Legal Business Name): CHARIS A VENDITTI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2010
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 MYRTLE ST STE 290
ERIE PA
16502-4609
US

IV. Provider business mailing address

2315 MYRTLE ST STE 290
ERIE PA
16502-4609
US

V. Phone/Fax

Practice location:
  • Phone: 814-879-6636
  • Fax: 814-452-5015
Mailing address:
  • Phone: 814-879-6636
  • Fax: 814-452-5015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberMD452185
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD452185
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: