Provider Demographics
NPI:1912934183
Name:WELCH, MICHAEL G (DPM)
Entity type:Individual
Prefix:PROF
First Name:MICHAEL
Middle Name:G
Last Name:WELCH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:750 S WHITE HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-2000
Mailing Address - Country:US
Mailing Address - Phone:609-567-0606
Mailing Address - Fax:
Practice Address - Street 1:408 CHRIS GAUPP DR
Practice Address - Street 2:SUITE 300
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-4486
Practice Address - Country:US
Practice Address - Phone:609-404-0700
Practice Address - Fax:609-404-0712
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00178000213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1912934183OtherINDIVIDUAL NPI
NJ0736309Medicaid
NJ7820240001OtherDMERC
NJ3763307Medicaid
NJ5598000002OtherDMERC
NJ1912934183OtherINDIVIDUAL NPI
NJ60088841OtherHORIZON NJ HEALTH