Provider Demographics
NPI:1578615365
Name:WELCH, MARTHA G (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:G
Last Name:WELCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:952 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-1740
Mailing Address - Country:US
Mailing Address - Phone:212-861-6816
Mailing Address - Fax:212-235-4234
Practice Address - Street 1:15 E 91ST ST
Practice Address - Street 2:B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-0648
Practice Address - Country:US
Practice Address - Phone:212-369-3566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY113080-12084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry