Provider Demographics
NPI:1477526200
Name:DINWIDDIE, CHARLES B JR (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:B
Last Name:DINWIDDIE
Suffix:JR
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 1:3700 N EVERBROOK LN
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-5269
Mailing Address - Country:US
Mailing Address - Phone:765-288-8577
Mailing Address - Fax:
Practice Address - Street 1:3700 N EVERBROOK LN
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-5269
Practice Address - Country:US
Practice Address - Phone:765-288-8577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1033750207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100106630AMedicaid
IN100106630AMedicaid
C24626Medicare UPIN