Provider Demographics
NPI:1518234889
Name:WELTY, CARSON (MD)
Entity Type:Individual
Prefix:
First Name:CARSON
Middle Name:
Last Name:WELTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 S BASCOM AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2603
Mailing Address - Country:US
Mailing Address - Phone:888-334-1000
Mailing Address - Fax:408-885-6718
Practice Address - Street 1:750 S BASCOM AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2603
Practice Address - Country:US
Practice Address - Phone:888-334-1000
Practice Address - Fax:408-885-6718
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-30
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA118872208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics