Healthcare Provider Details

I. General information

NPI: 1992828750
Provider Name (Legal Business Name): DEBRA ELLYN WELTMAN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 09/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 KING FARM BLVD SUITE 135
ROCKVILLE MD
20850-5979
US

IV. Provider business mailing address

800 KING FARM BLVD SUITE 135
ROCKVILLE MD
20850-5979
US

V. Phone/Fax

Practice location:
  • Phone: 301-208-8638
  • Fax: 301-869-3172
Mailing address:
  • Phone: 301-208-8638
  • Fax: 301-869-3172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number0618001526
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberTUV006668
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberTA1928
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: