Provider Demographics
NPI:1619158623
Name:MCELWEE, CHARLES
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:MCELWEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 NORTHFIELD DR E
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:IN
Mailing Address - Zip Code:46105-9475
Mailing Address - Country:US
Mailing Address - Phone:765-522-1774
Mailing Address - Fax:765-522-1797
Practice Address - Street 1:108 E PAT RADY WAY
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:IN
Practice Address - Zip Code:46105-9361
Practice Address - Country:US
Practice Address - Phone:800-416-2434
Practice Address - Fax:765-588-0408
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN17001198A237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist