MEDICARE: DR. CHARLES WEBER D.O.

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	2084P0800X	Psychiatry Physician	0102201505	VA
2	2084P0800X	Psychiatry Physician	063450	GA

General Provider Information

NPI Number	:	1841277258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES WEBER D.O.

Provider Business Mailing Address
First Line	:	5447 CAMPGLEN DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-7632
Country	:	US
Telephone Number	:	719-526-7155
Fax Number	:

Provider Business Practice Location Address
First Line	:	6541 SPECKER AVE BLDG 830
Second Line	:
City	:	FORT CARSON
State	:	CO
Zip	:	80913-4263
Country	:	US
Telephone Number	:	719-526-7155
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	02/17/2025

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