Provider Demographics
NPI:1235105305
Name:WELCH, CHARLES FELIX (AUD)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:FELIX
Last Name:WELCH
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:1 GUTHRIE SQ
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-1625
Practice Address - Country:US
Practice Address - Phone:570-888-5858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT000460L231H00000X
NY000921-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015473210001Medicaid
PA640004158OtherRR MEDICARE PIN
PAGU040061OtherPA MEDICARE GROUP
PACC9269OtherRR MEDICARE GROUP
NY01810044Medicaid
PACC9269OtherRR MEDICARE GROUP
PA200027N91Medicare PIN
PA0015473210001Medicaid