Provider Demographics
NPI:1396746236
Name:WELTON, SCOTT T (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:T
Last Name:WELTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 N ELM ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-6302
Mailing Address - Country:US
Mailing Address - Phone:336-274-9617
Mailing Address - Fax:
Practice Address - Street 1:4983 DELHI AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-5380
Practice Address - Country:US
Practice Address - Phone:513-347-7237
Practice Address - Fax:513-347-6567
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35080894W2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2351128Medicaid
IN200425390AMedicaid
KY64069859Medicaid
H65636Medicare UPIN
OH300136153Medicare PIN
OH2351128Medicaid