Provider Demographics
NPI:1164462461
Name:WELCH, RAYMOND HENRY (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:HENRY
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 1:845 N MAIN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-5700
Mailing Address - Country:US
Mailing Address - Phone:401-521-7300
Mailing Address - Fax:401-521-7307
Practice Address - Street 1:845 N MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-5700
Practice Address - Country:US
Practice Address - Phone:401-521-7300
Practice Address - Fax:401-521-7307
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD6829207N00000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI200786OtherBCBS-BLUECHIP
RI9001732Medicaid
RI03-00135OtherUNITED HEALTH CARE
RI0000023500OtherBLUE CROSS BLUE SHIELD RI
RI713938OtherTUFTS
RI03-00135OtherUNITED HEALTH CARE
RI9001732Medicaid