Provider Demographics
NPI:1760741128
Name:WELCOME, CAROLYN B (PA-C)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:B
Last Name:WELCOME
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:CAROLYN
Other - Middle Name:BEACH
Other - Last Name:WELCOME
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:123 W 79TH ST
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-6480
Mailing Address - Country:US
Mailing Address - Phone:212-799-1121
Mailing Address - Fax:212-799-2377
Practice Address - Street 1:123 W 79TH ST
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-6480
Practice Address - Country:US
Practice Address - Phone:212-799-1121
Practice Address - Fax:212-799-2377
Is Sole Proprietor?:No
Enumeration Date:2012-05-04
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011737363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical