Provider Demographics
NPI:1437215423
Name:WELDER, LINDA RUTH (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:RUTH
Last Name:WELDER
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:PO BOX 839
Mailing Address - Street 2:1404 N HIGH ST
Mailing Address - City:HILLSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45133
Mailing Address - Country:US
Mailing Address - Phone:937-393-9494
Mailing Address - Fax:937-393-8471
Practice Address - Street 1:1404 N HIGH ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133
Practice Address - Country:US
Practice Address - Phone:937-393-9494
Practice Address - Fax:937-393-8471
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35050873W208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0560834Medicaid
WE0550363Medicare ID - Type Unspecified
A15768Medicare UPIN
WE0550364Medicare ID - Type Unspecified
OH0560834Medicaid