Healthcare Provider Details

I. General information

NPI: 1982600342
Provider Name (Legal Business Name): GREGORY MARK WELSH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 04/28/2024
Certification Date: 04/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PASTEUR DR
STANFORD CA
94305-2200
US

IV. Provider business mailing address

300 PASTEUR DR
STANFORD CA
94305-2200
US

V. Phone/Fax

Practice location:
  • Phone: 650-723-4000
  • Fax:
Mailing address:
  • Phone: 650-723-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC167888
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberC167888
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1982600342
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer
# 2
Identifier4587164
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerAETNA
# 3
Identifier1090364
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer
# 4
Identifier3711
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerREGENCE
# 5
Identifier0229991
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerL&I AND CRIME VICTIMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: