Provider Demographics
NPI:1851738165
Name:WELLS, CHARLES WILLIAM
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:WILLIAM
Last Name:WELLS
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:CHARLES
Other - Middle Name:WILLIAM
Other - Last Name:WELLS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 367 200 NORTH ST APT 4
Mailing Address - Street 2:A1 CHUCKS TAXI
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13761
Mailing Address - Country:US
Mailing Address - Phone:607-349-1874
Mailing Address - Fax:
Practice Address - Street 1:101 MITCHELL ST APT 1
Practice Address - Street 2:A1 CHUCKS TAXI
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760
Practice Address - Country:US
Practice Address - Phone:607-349-1874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY984464539261QA0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility