1598250789 NPI number — BENJAMIN MARTIN WELCH DPT

Table of content: BENJAMIN MARTIN WELCH DPT (NPI 1598250789)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598250789 NPI number — BENJAMIN MARTIN WELCH DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WELCH
Provider First Name:
BENJAMIN
Provider Middle Name:
MARTIN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598250789
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/29/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 WALTER WARD BLVD STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ABINGDON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21009-1285
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-512-8337
Provider Business Mailing Address Fax Number:
443-327-5282

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 WALTER WARD BLVD STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ABINGDON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21009-1285
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-512-8337
Provider Business Practice Location Address Fax Number:
443-327-5282
Provider Enumeration Date:
06/29/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 27023 . This is a "STATE OF MARYLAND" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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