Provider Demographics
NPI:1811329907
Name:WELCH, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:WELCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 KASSON RD
Mailing Address - Street 2:
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-2271
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:346 N MIDLER AVE
Practice Address - Street 2:STE 38
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13206-2277
Practice Address - Country:US
Practice Address - Phone:315-437-0325
Practice Address - Fax:315-437-0958
Is Sole Proprietor?:No
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14000028288237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist