Provider Demographics
NPI:1467676122
Name:WELCH, TAMARA LYNN (MD)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:LYNN
Last Name:WELCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1111 BENFIELD BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-3002
Mailing Address - Country:US
Mailing Address - Phone:410-729-5100
Mailing Address - Fax:410-729-5156
Practice Address - Street 1:129 LUBRANO DR
Practice Address - Street 2:SUITE 100
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7566
Practice Address - Country:US
Practice Address - Phone:410-266-5852
Practice Address - Fax:410-266-5095
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2012-05-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD430565207Q00000X
MDD72289207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0117OtherCAREFIRST BLUE CHOICE
MD221203000Medicaid
MDP19745OtherCAREFIRST POS
MD252175OtherEHP/PRIORITY PARTNERS
MD8158133OtherAETNA HMO
MD7604961OtherAETNA PPO
MD974740-01OtherCAREFIRST BCBS OF MARYLAND
MD227828ZARMedicare PIN