Provider Demographics
NPI:1255314373
Name:WELTMAN, ALLYSE L (MD)
Entity Type:Individual
Prefix:
First Name:ALLYSE
Middle Name:L
Last Name:WELTMAN
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 1:2296 OPITZ BLVD
Mailing Address - Street 2:#440
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191
Mailing Address - Country:US
Mailing Address - Phone:703-878-0740
Mailing Address - Fax:703-878-3933
Practice Address - Street 1:2296 OPITZ BLVD
Practice Address - Street 2:#440
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191
Practice Address - Country:US
Practice Address - Phone:703-878-0740
Practice Address - Fax:703-878-3933
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101234869174400000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010009081Medicaid
002986A47Medicare ID - Type Unspecified