Provider Demographics
NPI:1174519235
Name:WELCH, JUDY (MD)
Entity type:Individual
Prefix:DR
First Name:JUDY
Middle Name:
Last Name:WELCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 BEACH ST
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-2801
Mailing Address - Country:US
Mailing Address - Phone:207-294-3500
Mailing Address - Fax:207-283-4207
Practice Address - Street 1:9 BEACH ST
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-2801
Practice Address - Country:US
Practice Address - Phone:207-294-3500
Practice Address - Fax:207-283-4207
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME013627207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME132320000Medicaid
ME01-0523031OtherTAX ID
ME01-0523031OtherTAX ID
MEMM5533Medicare ID - Type Unspecified