Provider Demographics
NPI:1124198502
Name:WELTER, RYAN JOHN PAUL (MD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:JOHN PAUL
Last Name:WELTER
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 1:465 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NORTH ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02760-2129
Mailing Address - Country:US
Mailing Address - Phone:508-316-0725
Mailing Address - Fax:508-316-1685
Practice Address - Street 1:465 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NORTH ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02760-2129
Practice Address - Country:US
Practice Address - Phone:508-316-0725
Practice Address - Fax:508-316-1685
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA206588207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA713196OtherHARVARD PILGRIM
MA000000026469OtherBMC
MA0193810Medicaid
MA206588OtherTUFTS
MA8932913001OtherCIGNA
MAJ24803OtherBCBS
MA2864103OtherAETNA
MAH63835Medicare UPIN
MAA34167Medicare PIN