Healthcare Provider Details

I. General information

NPI: 1518953421
Provider Name (Legal Business Name): RANDON SCOTT WELTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4211 STATE ROUTE 44 STE 203
ROOTSTOWN OH
44272-9733
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 330-325-3202
  • Fax: 833-606-1565
Mailing address:
  • Phone: 330-325-3202
  • Fax: 833-606-1565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35.061972
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: