MEDICARE: DR. KEVIN MICHAEL WELCH DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	SC003430L	PA
2	213ES0131X	Foot Surgery Podiatrist	SC003430L	PA

General Provider Information

NPI Number	:	1982709580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN MICHAEL WELCH DPM

Provider Business Mailing Address
First Line	:	966 CARPENTER RD
Second Line	:
City	:	MILTON
State	:	PA
Zip	:	17847
Country	:	US
Telephone Number	:	570-742-9636
Fax Number	:	570-742-4661

Provider Business Practice Location Address
First Line	:	1201 GRAMPIAN BLVD STE 2F
Second Line	:
City	:	WILLIAMSPORT
State	:	PA
Zip	:	17701-1965
Country	:	US
Telephone Number	:	703-212-0205
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	07/21/2023

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