Provider Demographics
NPI:1881821544
Name:WELCH, RONALD (PA)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:
Last Name:WELCH
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 SWAIN RD
Mailing Address - Street 2:
Mailing Address - City:RUMFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04276-3800
Mailing Address - Country:US
Mailing Address - Phone:207-364-7955
Mailing Address - Fax:
Practice Address - Street 1:15 WAYSIDE AVE
Practice Address - Street 2:
Practice Address - City:BRIDGTON
Practice Address - State:ME
Practice Address - Zip Code:04009-1231
Practice Address - Country:US
Practice Address - Phone:207-647-4404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-19
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA-681363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant