Healthcare Provider Details

I. General information

NPI: 1194287599
Provider Name (Legal Business Name): COURTNEY ALICE WELCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2019
Last Update Date: 07/26/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 HILLANDALE RD STE 25A
DURHAM NC
27705-2671
US

IV. Provider business mailing address

1821 HILLANDALE RD STE 25A
DURHAM NC
27705-2671
US

V. Phone/Fax

Practice location:
  • Phone: 919-613-5707
  • Fax:
Mailing address:
  • Phone: 919-613-5707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2023-02764
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number2023-02764
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number2023-02764
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2023-02764
License Number StateNC
# 5
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: