Provider Demographics
NPI:1467417386
Name:WELSH, JAMES D (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:D
Last Name:WELSH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:MR
Other - First Name:J
Other - Middle Name:DOUGLAS
Other - Last Name:WELSH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:P.O. BOX 1965
Mailing Address - Street 2:SEPI
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45501
Mailing Address - Country:US
Mailing Address - Phone:937-399-3571
Mailing Address - Fax:937-717-9028
Practice Address - Street 1:1427 BUSINESS CENTER CT
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45410-3300
Practice Address - Country:US
Practice Address - Phone:937-254-0160
Practice Address - Fax:937-254-1478
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50-002096363AM0700X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHWEPA23361Medicare PIN