Provider Demographics
NPI:1700851839
Name:WELCH, AMY G
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:G
Last Name:WELCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1537 ELMIRA ST
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-9254
Mailing Address - Country:US
Mailing Address - Phone:570-888-6803
Mailing Address - Fax:570-888-2025
Practice Address - Street 1:1537 ELMIRA ST
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-9254
Practice Address - Country:US
Practice Address - Phone:570-888-6803
Practice Address - Fax:570-888-2025
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2011-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA000977363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q23425Medicare UPIN
081927Medicare ID - Type Unspecified