Healthcare Provider Details

I. General information

NPI: 1619943644
Provider Name (Legal Business Name): MARK LAWRENCE WELCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 08/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6410 ROCKLEDGE DR SUITE 300
BETHESDA MD
20817-1809
US

IV. Provider business mailing address

6410 ROCKLEDGE DR SUITE 300
BETHESDA MD
20817-1809
US

V. Phone/Fax

Practice location:
  • Phone: 301-564-3131
  • Fax: 301-564-6391
Mailing address:
  • Phone: 301-564-3131
  • Fax: 301-564-6391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number101058507
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberD51120
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: