Healthcare Provider Details

I. General information

NPI: 1851565451
Provider Name (Legal Business Name): ROBERT MICHAEL WELTON M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2008
Last Update Date: 01/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 MAIN ST STE 115
HOLYOKE MA
01040-5396
US

IV. Provider business mailing address

611 HOPMEADOW ST
SIMSBURY CT
06070-2449
US

V. Phone/Fax

Practice location:
  • Phone: 413-538-6213
  • Fax: 413-538-6862
Mailing address:
  • Phone: 860-217-1650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License Number256257
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number256257
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: