Provider Demographics
NPI:1275577348
Name:WELCH, THOMAS R (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:R
Last Name:WELCH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:725 IRVING AVE
Mailing Address - Street 2:STE 401
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1603
Mailing Address - Country:US
Mailing Address - Phone:315-464-6340
Mailing Address - Fax:315-464-6329
Practice Address - Street 1:725 IRVING AVE
Practice Address - Street 2:STE 401
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1603
Practice Address - Country:US
Practice Address - Phone:315-464-6340
Practice Address - Fax:315-464-6329
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2012-05-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1204622080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00526729Medicaid
NYA81445Medicare UPIN
NY00526729Medicaid