Provider Demographics
NPI:1285605659
Name:WELKOVICH, BRUCE (MD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:WELKOVICH
Suffix:
Gender:M
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 1145
Mailing Address - Street 2:
Mailing Address - City:GLEN
Mailing Address - State:NH
Mailing Address - Zip Code:03838-1145
Mailing Address - Country:US
Mailing Address - Phone:603-383-9468
Mailing Address - Fax:
Practice Address - Street 1:789 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-2526
Practice Address - Country:US
Practice Address - Phone:603-742-5252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183415207P00000X
NH10442207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHAA98576OtherHARVARD PILGRIM NH
NH0105506Y0NH02OtherBCBS THRU SEACOAST ER
NH30206944Medicaid
ME432622899Medicaid
NHP00634687OtherRAILROAD MEDICARE
NHG34684Medicare UPIN
NHP00634687OtherRAILROAD MEDICARE