Provider Demographics
NPI:1811999311
Name:WELCH, THOMAS G (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:G
Last Name:WELCH
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 1:2409 CHERRY ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43608-2625
Mailing Address - Country:US
Mailing Address - Phone:419-251-3700
Mailing Address - Fax:419-251-3835
Practice Address - Street 1:2409 CHERRY ST
Practice Address - Street 2:SUITE 100
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608-2625
Practice Address - Country:US
Practice Address - Phone:419-251-3700
Practice Address - Fax:419-251-3835
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35033047207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH00102OtherPARAMOUNT
MI4127170Medicaid
OH060055318OtherRAILROAD MEDICARE
OH0171684Medicaid
MI0605800341OtherBLUE CROSS BLUE SHIELD MICHIGAN
OH000000140662OtherANTHEM
MI4127170Medicaid
OH0864652Medicare PIN
MIM85370001Medicare PIN
OH0171684Medicaid