Healthcare Provider Details

I. General information

NPI: 1437152014
Provider Name (Legal Business Name): DAVID LEE WELDY MD,PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 02/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 GLENDALE AVE
TOLEDO OH
43614-2426
US

IV. Provider business mailing address

3355 GLENDALE AVE FL 3
TOLEDO OH
43614-2426
US

V. Phone/Fax

Practice location:
  • Phone: 419-383-5555
  • Fax: 419-383-3113
Mailing address:
  • Phone: 419-388-5555
  • Fax: 419-383-3113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35-05-2329-W
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number35-05-2329-W
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: