Provider Demographics
NPI:1548259146
Name:WELCH, PAUL G (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:G
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 1:12931 OAK HILL AVE
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-2914
Mailing Address - Country:US
Mailing Address - Phone:301-797-9600
Mailing Address - Fax:301-797-3854
Practice Address - Street 1:103 MARCLEY DR
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-2977
Practice Address - Country:US
Practice Address - Phone:304-263-0911
Practice Address - Fax:304-263-0896
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0036460207RN0300X
WV21663207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810000572Medicaid
MD405937900Medicaid
I12948Medicare UPIN
MD405937900Medicaid
WV4139611Medicare PIN
248LMedicare ID - Type UnspecifiedGROUP