Provider Demographics
NPI:1114189578
Name:WELLISCH, OFER MENACHEM (MD)
Entity Type:Individual
Prefix:DR
First Name:OFER
Middle Name:MENACHEM
Last Name:WELLISCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:29 HOSPITAL PLZ
Mailing Address - Street 2:SUITE 602
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-3602
Mailing Address - Country:US
Mailing Address - Phone:203-276-2451
Mailing Address - Fax:203-276-2452
Practice Address - Street 1:29 HOSPITAL PLZ
Practice Address - Street 2:SUITE 602
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-3602
Practice Address - Country:US
Practice Address - Phone:203-276-2451
Practice Address - Fax:203-276-2452
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT56314207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine