Provider Demographics
NPI:1538345343
Name:WELDT, CHARITY ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:CHARITY
Middle Name:ELIZABETH
Last Name:WELDT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHARITY
Other - Middle Name:ELIZABETH
Other - Last Name:ALEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 E 3RD ST
Mailing Address - Street 2:400 EAST THIRD STREET
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-1951
Mailing Address - Country:US
Mailing Address - Phone:218-786-8346
Mailing Address - Fax:
Practice Address - Street 1:1180 CHANDLER DR
Practice Address - Street 2:
Practice Address - City:SPOONER
Practice Address - State:WI
Practice Address - Zip Code:54801-2204
Practice Address - Country:US
Practice Address - Phone:715-635-2151
Practice Address - Fax:715-635-8768
Is Sole Proprietor?:No
Enumeration Date:2008-01-11
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ43453207Q00000X
AZ81021207Q00000X
WI69510-20207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ43453OtherAZ LICENSE
AZ563695Medicaid
AZ81021OtherTRAINING PERMIT
AZ81021OtherTRAINING PERMIT