Provider Demographics
NPI:1487694477
Name:WELCH, PETER C (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:C
Last Name:WELCH
Suffix:
Gender:M
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:PO BOX 333
Mailing Address - Street 2:
Mailing Address - City:CONGERS
Mailing Address - State:NY
Mailing Address - Zip Code:10920-0333
Mailing Address - Country:US
Mailing Address - Phone:914-273-3404
Mailing Address - Fax:914-273-9647
Practice Address - Street 1:272 LAKE SHORE DR E
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-6212
Practice Address - Country:US
Practice Address - Phone:914-589-7093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY124794207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY980534Medicaid
NY980534Medicaid
NY08A811Medicare PIN