Provider Demographics
NPI:1225395247
Name:WELSH, GWENDOLYN LEIGH
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:LEIGH
Last Name:WELSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5314 DELHI AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45238-5390
Mailing Address - Country:US
Mailing Address - Phone:513-347-6922
Mailing Address - Fax:513-347-6955
Practice Address - Street 1:5314 DELHI AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-5390
Practice Address - Country:US
Practice Address - Phone:513-347-6922
Practice Address - Fax:513-347-6955
Is Sole Proprietor?:No
Enumeration Date:2012-04-15
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.011746207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH357510Medicare PIN