Provider Demographics
NPI:1700880648
Name:WELCH, MARLENE CALDERON (MD)
Entity Type:Individual
Prefix:DR
First Name:MARLENE
Middle Name:CALDERON
Last Name:WELCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARLENE
Other - Middle Name:S
Other - Last Name:CALDERON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4235 SECOR RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4231
Mailing Address - Country:US
Mailing Address - Phone:419-473-3561
Mailing Address - Fax:
Practice Address - Street 1:6525 SECOR RD
Practice Address - Street 2:
Practice Address - City:LAMBERTVILLE
Practice Address - State:MI
Practice Address - Zip Code:48144-9431
Practice Address - Country:US
Practice Address - Phone:419-479-5897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35084562208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2489472Medicaid
OHH419670Medicare PIN
I09329Medicare UPIN
MIN11220062Medicare PIN