Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Charles Wisniewski, DO

Individual provider Psychiatry Physician · NPI 1770997587

Dr. Charles Wisniewski, DO is a Psychiatry in Philadelphia, Pennsylvania. Graduated from Rutgers New Jersey Medical School in 2014, 12 years ago. Practices with Main Line Healthcare, a 1,153-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Pennsylvania.

Years since qualifying
12
Trained at
Rutgers New Jersey Medical School
Licensed in
PA
In the registry since
2014
Specialties on file
2
What do these letters mean?
DO — Doctor of Osteopathic Medicine
A fully licensed physician, trained like an MD with additional musculoskeletal training. Equivalent practice rights in all 50 states.

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Practice location Address checks out

4641 Roosevelt Blvd
Philadelphia, PA 19124-2343
Phone: (215) 831-2600
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 130 S Bryn Mawr Ave, Bryn Mawr, PA 19010-3121 — (484) 337-4286

Specialties & licences

Adolescent and Children Mental Health Clinic/Center (primary) Taxonomy 261QM0855X
Psychiatry Physician Taxonomy 2084P0800X · Licence OS019121 (PA)

Record details

NPI number1770997587
Entity typeIndividual (Type 1)
GenderMale
Credentials DO
Sole proprietorYes
NPI enumeratedJune 19, 2014
Last updated in NPPESOctober 12, 2018

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPSYCHIATRY
Medical schoolRUTGERS NEW JERSEY MEDICAL SCHOOL
Graduated 2014 (12 years in practice)
Group practice Main Line Healthcare — 1153 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

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