Provider Demographics
NPI:1407848062
Name:WELT, DANIEL A (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:A
Last Name:WELT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4235 SECOR RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4231
Mailing Address - Country:US
Mailing Address - Phone:419-471-1700
Mailing Address - Fax:419-471-9113
Practice Address - Street 1:5742 PARK CENTER CT
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-1480
Practice Address - Country:US
Practice Address - Phone:419-471-1700
Practice Address - Fax:419-471-9113
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35074905W207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH080159894OtherRAILROAD MEDICARE
OH2126274Medicaid
OHH022211Medicare PIN
OH2126274Medicaid
OHG97410Medicare UPIN