MEDICARE: AMY G WELCH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	OA000977	PA

General Provider Information

NPI Number	:	1700851839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY G WELCH

Provider Business Mailing Address
First Line	:	1537 ELMIRA ST
Second Line	:
City	:	SAYRE
State	:	PA
Zip	:	18840-9254
Country	:	US
Telephone Number	:	570-888-6803
Fax Number	:	570-888-2025

Provider Business Practice Location Address
First Line	:	1537 ELMIRA ST
Second Line	:
City	:	SAYRE
State	:	PA
Zip	:	18840-9254
Country	:	US
Telephone Number	:	570-888-6803
Fax Number	:	570-888-2025

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	04/17/2011

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Directions to “ AMY G WELCH ” Practice Location

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