Provider Demographics
NPI:1093753303
Name:WELCH, DEREK C (MD)
Entity Type:Individual
Prefix:DR
First Name:DEREK
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 1:1010 AIRPARK CENTER DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37217-5200
Mailing Address - Country:US
Mailing Address - Phone:615-221-4447
Mailing Address - Fax:615-234-2511
Practice Address - Street 1:1010 AIRPARK CENTER DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37217-5200
Practice Address - Country:US
Practice Address - Phone:615-562-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36584207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN100049937OtherPHP TENNCARE
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TN37819OtherTLC TENNCARE
TN4128532OtherBLUE SHIELD
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AL009938109Medicaid
TN198281OtherUNISON TENNCARE
KY64106099Medicaid
VA010355915Medicaid
TN37819OtherTLC TENNCARE