Provider Demographics
NPI:1164596367
Name:WELTHER, MICHAEL J (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:WELTHER
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:PO BOX 61
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05250-0061
Mailing Address - Country:US
Mailing Address - Phone:802-430-7254
Mailing Address - Fax:
Practice Address - Street 1:9 CHURCH STREET
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05250
Practice Address - Country:US
Practice Address - Phone:802-375-6566
Practice Address - Fax:802-375-6828
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420007598207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
8000108OtherLADIES FIRST
WELT00007333OtherVT BLUE CROSS
020009326OtherRAILROAD MEDICARE
10003016OtherCDPHP
VTWEVT9138Medicaid
414900OtherCIGNA
VT0473830Medicaid
08286OtherMVP
0009138OtherTRICARE
030310607OtherEMPLOYEE BENEFIT
WEVT9138OtherGREAT WEST
VT1164596367Medicare Oscar/Certification
WEVT9138OtherGREAT WEST
VT9138Medicare ID - Type Unspecified