Provider Demographics
NPI:1750510848
Name:WELCH, JOHN C JR (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:WELCH
Suffix:JR
Gender:M
Credentials:DO
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Mailing Address - Street 1:105 RIDGEHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-2640
Mailing Address - Country:US
Mailing Address - Phone:607-786-4822
Mailing Address - Fax:607-786-3837
Practice Address - Street 1:105 RIDGEHAVEN DR
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-2640
Practice Address - Country:US
Practice Address - Phone:607-786-4822
Practice Address - Fax:607-786-3837
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2021-03-18
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Provider Licenses
StateLicense IDTaxonomies
NY258543207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03457710Medicaid
NYJ400073599Medicare PIN