Provider Demographics
NPI:1972355139
Name:WELCH, PATRICK M
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:M
Last Name:WELCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 ORANGE CENTER RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-3420
Mailing Address - Country:US
Mailing Address - Phone:203-745-8896
Mailing Address - Fax:
Practice Address - Street 1:322 E MAIN ST STE 1B
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-3136
Practice Address - Country:US
Practice Address - Phone:203-488-7228
Practice Address - Fax:203-204-1415
Is Sole Proprietor?:No
Enumeration Date:2024-04-02
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT013065363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily