1992896054 NPI number — MRS. KAREN TERESA WELCH ANP

Table of content: MRS. KAREN TERESA WELCH ANP (NPI 1992896054)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992896054 NPI number — MRS. KAREN TERESA WELCH ANP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WELCH
Provider First Name:
KAREN
Provider Middle Name:
TERESA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ANP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PETRINO
Provider Other First Name:
KAREN
Provider Other Middle Name:
TERESA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1992896054
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/22/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 GROVE PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MELROSE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02176-4617
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-531-5738
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4 VIRGINIA LANE
Provider Second Line Business Practice Location Address:
DAF MEDICAL ASSOCIATES INC
Provider Business Practice Location Address City Name:
STONEHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02180
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-438-4625
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/27/2006

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: 163W00000X , with the licence number:  139914 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X , with the licence number: 139914 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: NP9607 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0710130 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P0039016 . This is a "MEDICARE RR" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".