Basic Information
| Provider Information | |||||||||
| NPI: | 1912075029 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEDDLE | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | O. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | II | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2502 25TH ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 472013728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8123728883 | ||||||||
| FaxNumber: | 8123728964 | ||||||||
| Practice Location | |||||||||
| Address1: | 2502 25TH ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 472013728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8123728883 | ||||||||
| FaxNumber: | 8123728964 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 01021260A | IN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.