Basic Information
| Provider Information | |||||||||
| NPI: | 1750503140 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WELCH | ||||||||
| FirstName: | MARTHA | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1850 W ARLINGTON BLVD | ||||||||
| Address2: | PHYSICIANS EAST | ||||||||
| City: | GREENVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278345704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2524136740 | ||||||||
| FaxNumber: | 2524136740 | ||||||||
| Practice Location | |||||||||
| Address1: | 1711 E ARLINGTON BLVD | ||||||||
| Address2: | PHYSICIANS EAST, P.A. | ||||||||
| City: | GREENVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278585872 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2523554357 | ||||||||
| FaxNumber: | 2523554187 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2007 | ||||||||
| LastUpdateDate: | 09/19/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QA0505X | 2009-01583 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine |
ID Information
| ID | Type | State | Issuer | Description | 5913640 | 05 | NC | MEDICAID | 1561Y | 01 | NC | BCBSNC | OTHER |