Provider Demographics
NPI:1497741383
Name:NOVICH-WELTER, LORRAINE C (MD)
Entity Type:Individual
Prefix:DR
First Name:LORRAINE
Middle Name:C
Last Name:NOVICH-WELTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:CN
Other - Last Name:WELTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:267 N SPRING CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:UT
Mailing Address - Zip Code:84332-9775
Mailing Address - Country:US
Mailing Address - Phone:435-792-9400
Mailing Address - Fax:435-792-4800
Practice Address - Street 1:267 N SPRING CREEK PKWY
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:UT
Practice Address - Zip Code:84332-9775
Practice Address - Country:US
Practice Address - Phone:435-792-9400
Practice Address - Fax:435-792-4800
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5924248-1205208100000X
IDM-10473208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID11004941OtherMEDICARE PTAN
UT5166950001Medicare NSC
ID11004941OtherMEDICARE PTAN