Provider Demographics
NPI:1598250789
Name:WELCH, BENJAMIN MARTIN (DPT)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:MARTIN
Last Name:WELCH
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WALTER WARD BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:MD
Mailing Address - Zip Code:21009-1285
Mailing Address - Country:US
Mailing Address - Phone:443-512-8337
Mailing Address - Fax:443-327-5282
Practice Address - Street 1:100 WALTER WARD BLVD STE 200
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:MD
Practice Address - Zip Code:21009-1285
Practice Address - Country:US
Practice Address - Phone:443-512-8337
Practice Address - Fax:443-327-5282
Is Sole Proprietor?:No
Enumeration Date:2018-06-29
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD27023OtherSTATE OF MARYLAND