Provider Demographics
NPI:1336181262
Name:VONDEREMBSE, CHARLES G (DO)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:G
Last Name:VONDEREMBSE
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:890 HIGHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-1233
Mailing Address - Country:US
Mailing Address - Phone:614-947-8900
Mailing Address - Fax:614-895-0998
Practice Address - Street 1:1728 SCHROCK ROAD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-1575
Practice Address - Country:US
Practice Address - Phone:614-947-8900
Practice Address - Fax:614-895-0998
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2009-06-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH34-001930 V207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4050833Medicare PIN