Healthcare Provider Details

I. General information

NPI: 1174519235
Provider Name (Legal Business Name): JUDY WELCH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 09/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 BEACH ST
SACO ME
04072-2801
US

IV. Provider business mailing address

9 BEACH ST
SACO ME
04072-2801
US

V. Phone/Fax

Practice location:
  • Phone: 207-294-3500
  • Fax: 207-283-4207
Mailing address:
  • Phone: 207-294-3500
  • Fax: 207-283-4207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number013627
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: