Provider Demographics
NPI:1336412733
Name:LORI C. NOVICH-WELTER, M.D., P.C.
Entity Type:Organization
Organization Name:LORI C. NOVICH-WELTER, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:NOVICH-WELTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-792-9400
Mailing Address - Street 1:267 N SPRING CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:UT
Mailing Address - Zip Code:84332-9775
Mailing Address - Country:US
Mailing Address - Phone:435-792-9400
Mailing Address - Fax:435-792-4800
Practice Address - Street 1:267 N SPRING CREEK PKWY
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:UT
Practice Address - Zip Code:84332-9775
Practice Address - Country:US
Practice Address - Phone:435-792-9400
Practice Address - Fax:435-792-4800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-15
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5924248208100000X
IDM-10473208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty