Provider Demographics
NPI:1477551208
Name:WELCH, TAMMY L (PAC)
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:L
Last Name:WELCH
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:20410 OBSERVATION DR STE 100
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-6419
Mailing Address - Country:US
Mailing Address - Phone:301-762-0277
Mailing Address - Fax:301-330-9108
Practice Address - Street 1:20410 OBSERVATION DR STE 100
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-6419
Practice Address - Country:US
Practice Address - Phone:301-762-0277
Practice Address - Fax:301-330-9108
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0002632363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P15631Medicare UPIN
MD470PR212Medicare PIN