Provider Demographics
NPI:1578950705
Name:WELDEN, CHARLES VICTOR IV (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:VICTOR
Last Name:WELDEN
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 LETTERED OLIVE LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-5716
Mailing Address - Country:US
Mailing Address - Phone:205-427-4558
Mailing Address - Fax:
Practice Address - Street 1:114 DOUGHTY ST STE 249
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-1900
Practice Address - Country:US
Practice Address - Phone:843-792-2301
Practice Address - Fax:843-876-7232
Is Sole Proprietor?:No
Enumeration Date:2015-04-27
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
SC52593207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC52593OtherMEDICAL LICENSE