Provider Demographics
NPI:1033201884
Name:WELZ, BETTINA MAXINE (MD)
Entity Type:Individual
Prefix:DR
First Name:BETTINA
Middle Name:MAXINE
Last Name:WELZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 FENWICK DR
Mailing Address - Street 2:
Mailing Address - City:PORT MATILDA
Mailing Address - State:PA
Mailing Address - Zip Code:16870-7533
Mailing Address - Country:US
Mailing Address - Phone:814-353-1095
Mailing Address - Fax:
Practice Address - Street 1:420 HOLMES ST
Practice Address - Street 2:
Practice Address - City:BELLEFONTE
Practice Address - State:PA
Practice Address - Zip Code:16823-1401
Practice Address - Country:US
Practice Address - Phone:814-355-6786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD043916L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016304730002Medicaid