Provider Demographics
NPI:1225441959
Name:VINING, CHARLES CHRISTIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:CHRISTIAN
Last Name:VINING
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 1:500 UNIVERSITY DR # C5522
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-2391
Mailing Address - Country:US
Mailing Address - Phone:800-243-1455
Mailing Address - Fax:717-531-3649
Practice Address - Street 1:500 UNIVERSITY DR STE C5522
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2391
Practice Address - Country:US
Practice Address - Phone:717-531-5965
Practice Address - Fax:717-531-3649
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2021-09-17
Deactivation Date:2015-01-14
Deactivation Code:
Reactivation Date:2017-03-09
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAMD4624702086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program