Provider Demographics
NPI:1487694469
Name:WELCH, MARY JANE (PHYSICIAN ASSISTANG)
Entity type:Individual
Prefix:MS
First Name:MARY JANE
Middle Name:
Last Name:WELCH
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANG
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Mailing Address - Street 1:840 HANSHAW ROAD
Mailing Address - Street 2:ASTHMAS & ALLERGY ASSOCIATES P.C.
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850
Mailing Address - Country:US
Mailing Address - Phone:607-257-6563
Mailing Address - Fax:607-257-1420
Practice Address - Street 1:840 HANSHAW ROAD
Practice Address - Street 2:ASTHMAS & ALLERGY ASSOCIATES P.C.
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850
Practice Address - Country:US
Practice Address - Phone:607-257-6563
Practice Address - Fax:607-257-1420
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2008-08-01
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Provider Licenses
StateLicense IDTaxonomies
NY000148207Q00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ22403Medicare UPIN