Provider Demographics
NPI:1194704809
Name:WELDY, CHARLES W (DPM)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:W
Last Name:WELDY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-1551
Mailing Address - Country:US
Mailing Address - Phone:724-746-1870
Mailing Address - Fax:724-746-6752
Practice Address - Street 1:111 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CANONSBURG
Practice Address - State:PA
Practice Address - Zip Code:15317-1551
Practice Address - Country:US
Practice Address - Phone:724-746-1870
Practice Address - Fax:724-746-6752
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002527L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010416250002Medicaid
PA0010416250002Medicaid
PAT28342Medicare UPIN