Provider Demographics
NPI:1558535716
Name:KIMPLE, CHARLES E (MA)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:E
Last Name:KIMPLE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3211 LIBERTY ST
Mailing Address - Street 2:LL1
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-2575
Mailing Address - Country:US
Mailing Address - Phone:814-868-1990
Mailing Address - Fax:814-866-0853
Practice Address - Street 1:3211 LIBERTY ST
Practice Address - Street 2:LL1
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-2575
Practice Address - Country:US
Practice Address - Phone:814-868-1990
Practice Address - Fax:814-866-0853
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT000544L237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAKI287146Medicare UPIN