Provider Demographics
NPI:1063406874
Name:WELSH, MARY F (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:F
Last Name:WELSH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4059
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07474-4059
Mailing Address - Country:US
Mailing Address - Phone:973-894-1263
Mailing Address - Fax:888-972-3703
Practice Address - Street 1:695 US HIGHWAY 46
Practice Address - Street 2:SUITE 400A
Practice Address - City:FAIRFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07004-1592
Practice Address - Country:US
Practice Address - Phone:973-894-1263
Practice Address - Fax:888-972-3703
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2017-01-17
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
PAMD054775L208600000X
NJ25MA062000800208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ682200Medicaid
NJ441771Medicare PIN
NJ682200Medicaid
NJ441771ZJ5NMedicare PIN