Provider Demographics
NPI:1740476761
Name:WELTY, KATHRYN (MD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:WELTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:CANNIFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:20055 LAKE CHABOT RD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-5331
Mailing Address - Country:US
Mailing Address - Phone:510-881-1490
Mailing Address - Fax:510-889-5806
Practice Address - Street 1:19850 LAKE CHABOT RD
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-4002
Practice Address - Country:US
Practice Address - Phone:510-881-1490
Practice Address - Fax:510-889-5806
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAML20008878207R00000X
CAA126967207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine