Provider Demographics
NPI:1114122678
Name:ROBERT A. WELIK, M.D., P.A.
Entity Type:Organization
Organization Name:ROBERT A. WELIK, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:AVRUM
Authorized Official - Last Name:WELIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-777-7011
Mailing Address - Street 1:904 SETON DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-1818
Mailing Address - Country:US
Mailing Address - Phone:301-777-7011
Mailing Address - Fax:301-724-2862
Practice Address - Street 1:919 SETON DR
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-1847
Practice Address - Country:US
Practice Address - Phone:301-777-7011
Practice Address - Fax:301-724-2862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0031875174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD47330100Medicaid
MD473301100Medicaid