MEDICARE: CHARLES H. WAPLES, M.D., P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD021105-E	PA

General Provider Information

NPI Number	:	1790055820
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLES H. WAPLES, M.D., P.C.

Provider Business Mailing Address
First Line	:	5801 SPRUCE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19139-3833
Country	:	US
Telephone Number	:	215-747-9195
Fax Number	:	215-474-3438

Provider Business Practice Location Address
First Line	:	5801 SPRUCE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19139-3833
Country	:	US
Telephone Number	:	215-747-9195
Fax Number	:	215-474-3438

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	CHARLES H. WAPLES JR.
Credential	:	M.D.
Telephone Number	:	215-747-9195

Provider Enumeration Date	:	01/05/2012
Last Update Date	:	01/05/2012

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