Basic Information
Provider Information
NPI: 1144663964
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WELSH
FirstName: KELLY
MiddleName: ANN
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 829641
Address2:  
City: PHILADELPHIA
State: PA
PostalCode: 191829641
CountryCode: US
TelephoneNumber: 2673705296
FaxNumber: 2152303725
Practice Location
Address1: 4897 YORK ROAD
Address2: 278
City: DOYLESTOWN
State: PA
PostalCode: 18901
CountryCode: US
TelephoneNumber: 2157944771
FaxNumber: 2157942576
Other Information
ProviderEnumerationDate: 04/10/2013
LastUpdateDate: 06/29/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/29/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XMD472981PAY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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