Healthcare Provider Details

I. General information

NPI: 1073225587
Provider Name (Legal Business Name): MR. CHARLES WEGMANN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2022
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 JEFFERSON HWY
NEW ORLEANS LA
70121-2429
US

IV. Provider business mailing address

1132 ELYSIAN FIELDS AVE
NEW ORLEANS LA
70117-8454
US

V. Phone/Fax

Practice location:
  • Phone: 866-634-7637
  • Fax:
Mailing address:
  • Phone: 504-298-9296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberLA21-2388
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: