Provider Demographics
NPI:1780617761
Name:CANONSBURG PODIATRY ASSOCIATES
Entity type:Organization
Organization Name:CANONSBURG PODIATRY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:W
Authorized Official - Last Name:WELDY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:724-746-1870
Mailing Address - Street 1:111 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-1551
Mailing Address - Country:US
Mailing Address - Phone:724-746-1870
Mailing Address - Fax:
Practice Address - Street 1:111 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CANONSBURG
Practice Address - State:PA
Practice Address - Zip Code:15317-1551
Practice Address - Country:US
Practice Address - Phone:724-746-1870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty