Healthcare Provider Details

I. General information

NPI: 1164385142
Provider Name (Legal Business Name): ROBERT JOSEPH WELCH PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 LANSING ST
AUBURN NY
13021-1983
US

IV. Provider business mailing address

127 RIVERGLEN RD
LIVERPOOL NY
13090-2811
US

V. Phone/Fax

Practice location:
  • Phone: 315-255-7011
  • Fax:
Mailing address:
  • Phone: 315-949-4599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: