Healthcare Provider Details

I. General information

NPI: 1275577348
Provider Name (Legal Business Name): THOMAS R WELCH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-1603
US

IV. Provider business mailing address

725 IRVING AVE STE 401
SYRACUSE NY
13210-1603
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-9180
  • Fax:
Mailing address:
  • Phone: 315-464-6340
  • Fax: 315-464-6329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME135047
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number120462
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License NumberME135047
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: