Provider Demographics
NPI:1225037377
Name:WELCH, ELIZABETH ANN (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:WELCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1287 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-1856
Mailing Address - Country:US
Mailing Address - Phone:401-272-2724
Mailing Address - Fax:401-272-2784
Practice Address - Street 1:1287 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-1856
Practice Address - Country:US
Practice Address - Phone:401-272-2724
Practice Address - Fax:401-272-2784
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI5338207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9001037Medicaid
RI079001037Medicare ID - Type Unspecified
RIC90205Medicare UPIN