Provider Demographics
NPI:1467581983
Name:WINTERS, CHARLES P (NBC-HIS)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:P
Last Name:WINTERS
Suffix:
Gender:M
Credentials:NBC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-3250
Mailing Address - Country:US
Mailing Address - Phone:814-943-4061
Mailing Address - Fax:
Practice Address - Street 1:304 UNION AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-3250
Practice Address - Country:US
Practice Address - Phone:814-943-4061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAFO2396237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
203902OtherBLUE CROSS BLUE SHIELD