Healthcare Provider Details

I. General information

NPI: 1700880648
Provider Name (Legal Business Name): MARLENE CALDERON WELCH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARLENE S CALDERON M.D.

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 05/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6525 SECOR RD
LAMBERTVILLE MI
48144-9431
US

IV. Provider business mailing address

4235 SECOR RD
TOLEDO OH
43623-4231
US

V. Phone/Fax

Practice location:
  • Phone: 419-479-5897
  • Fax:
Mailing address:
  • Phone: 419-473-3561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number35084562
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: