Provider Demographics
NPI:1922297365
Name:WELCH, ANGELA H (PA)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:H
Last Name:WELCH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:162 COMMERCIAL ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:FOREST CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28043-2849
Mailing Address - Country:US
Mailing Address - Phone:828-287-9325
Mailing Address - Fax:828-287-3594
Practice Address - Street 1:162 COMMERCIAL ST
Practice Address - Street 2:SUITE B
Practice Address - City:FOREST CITY
Practice Address - State:NC
Practice Address - Zip Code:28043-2849
Practice Address - Country:US
Practice Address - Phone:828-287-9325
Practice Address - Fax:828-287-3594
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC1244363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0599PAMedicaid