Provider Demographics
NPI:1740426865
Name:WALTER R. WELZANT MD PA
Entity Type:Organization
Organization Name:WALTER R. WELZANT MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:R
Authorized Official - Last Name:WELZANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-323-5490
Mailing Address - Street 1:7801 YORK RD
Mailing Address - Street 2:SUITE305
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7446
Mailing Address - Country:US
Mailing Address - Phone:410-337-5490
Mailing Address - Fax:410-583-5680
Practice Address - Street 1:7801 YORK RD
Practice Address - Street 2:SUITE305
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7446
Practice Address - Country:US
Practice Address - Phone:410-337-5490
Practice Address - Fax:410-583-5680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-18
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B69844Medicare UPIN