Healthcare Provider Details

I. General information

NPI: 1154093029
Provider Name (Legal Business Name): CORINNE ROSE WELSH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2021
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 OLD YORK RD
PHILADELPHIA PA
19141-3018
US

IV. Provider business mailing address

264 MANKIN AVE
HUNTINGDON VALLEY PA
19006-8708
US

V. Phone/Fax

Practice location:
  • Phone: 215-456-6933
  • Fax:
Mailing address:
  • Phone: 484-332-5319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA062894
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: