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General NPI Number Information
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NPI Number | 1891797759
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Entity Type | Individual
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Provider Name | MICHAEL A. VENDITTO DO
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Gender | Male
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Dates
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Enumeration Date | 08/11/2005
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Last Update Date | 03/03/2016
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Provider Practice Location Address
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Address Line | 4190 CITY AVE SUITE 315
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City | PHILADELPHIA
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State | PA
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Zip | 19131-1626
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Country | US
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Telephone | 215-871-6337
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Fax | 215-871-6347
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Provider Business Mailing Address
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Address Line | 4190 CITY AVE SUITE 315
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City | PHILADELPHIA
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State | PA
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Zip | 19131-1626
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Country | US
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Telephone | 215-871-6337
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Fax | 215-871-6347
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | OS003980L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 25MB06362800
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | OS003980L
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 25MB06362800
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License Number State | NJ
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Taxonomy #5
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | OS003980L
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License Number State | PA
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Taxonomy #6
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 25MB06362800
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License Number State | NJ
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