Provider Demographics
NPI:1619943644
Name:WELCH, MARK LAWRENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:LAWRENCE
Last Name:WELCH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6410 ROCKLEDGE DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-1809
Mailing Address - Country:US
Mailing Address - Phone:301-564-3131
Mailing Address - Fax:301-564-6391
Practice Address - Street 1:6410 ROCKLEDGE DR
Practice Address - Street 2:SUITE 300
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1809
Practice Address - Country:US
Practice Address - Phone:301-564-3131
Practice Address - Fax:301-564-6391
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2017-08-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA101058507207ND0101X
MDD51120207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
G00412-000Z30S12Medicare ID - Type Unspecified
G34935Medicare UPIN