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General NPI Number Information
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NPI Number | 1700956414
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Entity Type | Individual
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Provider Name | CHARLES W. WELLY D.O.
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Gender | Male
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 08/17/2021
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Provider Practice Location Address
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Address Line | 5 W BACK ST STE 101
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City | FINCASTLE
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State | VA
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Zip | 24090-4368
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Country | US
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Telephone | 540-769-3964
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Fax | 540-473-3458
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Provider Business Mailing Address
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Address Line | PO BOX 8310
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City | ROANOKE
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State | VA
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Zip | 24014-0310
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Country | US
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Telephone | 540-345-3556
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Fax | 540-342-2193
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2248
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0102204907
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License Number State | VA
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