Healthcare Provider Details

I. General information

NPI: 1720061906
Provider Name (Legal Business Name): ROBERT J WELSCH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 01/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 FLANDERS RD
EAST LYME CT
06333-1735
US

IV. Provider business mailing address

324 FLANDERS RD
EAST LYME CT
06333-1735
US

V. Phone/Fax

Practice location:
  • Phone: 860-739-6953
  • Fax: 860-739-2523
Mailing address:
  • Phone: 860-739-6953
  • Fax: 860-739-2523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number023094
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number23094
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: