Provider Demographics
NPI:1457434029
Name:WELSH, TERRENCE (MD)
Entity type:Individual
Prefix:DR
First Name:TERRENCE
Middle Name:
Last Name:WELSH
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 1:1611 27TH ST
Mailing Address - Street 2:BLDG. J, SUITE 202
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-6931
Mailing Address - Country:US
Mailing Address - Phone:740-354-3344
Mailing Address - Fax:740-353-0585
Practice Address - Street 1:1611 27TH ST
Practice Address - Street 2:BLDG. J, SUITE 202
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-6931
Practice Address - Country:US
Practice Address - Phone:740-354-3344
Practice Address - Fax:740-353-0585
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35060023174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0792941Medicaid
KY64869563Medicaid
OH0792941Medicaid
KY64869563Medicaid