Provider Demographics
NPI:1225354848
Name:PHILIP D WELCH M.D.
Entity Type:Organization
Organization Name:PHILIP D WELCH M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:D
Authorized Official - Last Name:WELCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-622-1055
Mailing Address - Street 1:801 BROADWAY
Mailing Address - Street 2:STE 628
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-4396
Mailing Address - Country:US
Mailing Address - Phone:206-622-1055
Mailing Address - Fax:206-215-6566
Practice Address - Street 1:801 BROADWAY
Practice Address - Street 2:STE 628
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-4396
Practice Address - Country:US
Practice Address - Phone:206-622-1055
Practice Address - Fax:206-215-6566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00018862207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1111368Medicaid
WAWE0424OtherREGENCE BLUE SHIELD
WA1111368Medicaid
WAWE0424OtherREGENCE BLUE SHIELD