Provider Demographics
NPI:1891796512
Name:WELCH, MARY R (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:R
Last Name:WELCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:3 DALE RD
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-3508
Mailing Address - Country:US
Mailing Address - Phone:716-655-2690
Mailing Address - Fax:716-655-2691
Practice Address - Street 1:565 ABBOTT RD
Practice Address - Street 2:DEPARTMENT OF PHYSICAL MEDICINE AND REHABILITATION
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14220-2039
Practice Address - Country:US
Practice Address - Phone:716-828-8260
Practice Address - Fax:716-828-3563
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY190403208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3007330OtherINDEPENDENT HEALTH
NY000523798004OtherBCBS
NY00010957002OtherUNIVERA
NY0140157OtherGHI
NY01575460Medicaid
NY00010957003OtherMERCY HOSPITAL UNIVERA
NY00010957004OtherUNIVERA
NY000523798003OtherBLUE CROSS BLUE SHIELD
NY0005237982OtherMERCY HOSPITAL BCBS
NYRB2233Medicare PIN
NY3007330OtherINDEPENDENT HEALTH
NY000523798004OtherBCBS
NY00010957004OtherUNIVERA
NYP00476407Medicare PIN