Provider Demographics
NPI:1356406219
Name:AVENDANO-WELCH, MARIA SOFIA B (MD)
Entity type:Individual
Prefix:DR
First Name:MARIA SOFIA
Middle Name:B
Last Name:AVENDANO-WELCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1978
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21802-1978
Mailing Address - Country:US
Mailing Address - Phone:410-749-1015
Mailing Address - Fax:410-749-0654
Practice Address - Street 1:223 PHILLIP MORRIS DR
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-1923
Practice Address - Country:US
Practice Address - Phone:410-548-1747
Practice Address - Fax:410-548-3783
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0051941208000000X
DEC10006517208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD119591300Medicaid
MD8451109Medicaid
NJ9022708Medicaid
MD8451109Medicaid
H55440Medicare UPIN