Provider Demographics
NPI:1881677516
Name:WELTY, KATHERINE M (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:M
Last Name:WELTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12395 S ORANGE BLOSSOM TRL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-6217
Mailing Address - Country:US
Mailing Address - Phone:407-438-8840
Mailing Address - Fax:407-438-8893
Practice Address - Street 1:651 W WARREN AVE STE 100
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-4036
Practice Address - Country:US
Practice Address - Phone:407-438-8840
Practice Address - Fax:407-438-8893
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2022-06-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME0068336207Q00000X
FLME68336207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5174561OtherAETNA
FL24506OtherBLUE CROSS BLUE SHEILD
FL7549512COtherCIGNA
FL31876TMedicare PIN
FLE61958Medicare UPIN