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General NPI Number Information
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NPI Number | 1679645881
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Entity Type | Individual
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Provider Name | KENNETH A WELTY JR M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1520 S MAIN ST SUITE 200
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City | DAYTON
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State | OH
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Zip | 45409-2698
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Country | US
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Telephone | 937-228-5115
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Fax | 937-228-4591
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Provider Business Mailing Address
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Address Line | 1520 S MAIN ST SUITE 200
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City | DAYTON
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State | OH
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Zip | 45409-2698
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Country | US
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Telephone | 937-228-5115
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Fax | 937-228-4591
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | 35044824
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License Number State | OH
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