1396823241 NPI number — MS. ERIN SUSAN WELCH PAC

Table of content: MS. ERIN SUSAN WELCH PAC (NPI 1396823241)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396823241 NPI number — MS. ERIN SUSAN WELCH PAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WELCH
Provider First Name:
ERIN
Provider Middle Name:
SUSAN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PAC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396823241
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9 HEALTHCARE DR
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
BIDDEFORD
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04005-9449
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-282-9080
Provider Business Mailing Address Fax Number:
207-282-9180

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4 SHAPE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENNEBUNK
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04043-6760
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-467-8930
Provider Business Practice Location Address Fax Number:
207-985-8459
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  PA001070 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 30334801 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 432406399 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".




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