Basic Information
| Provider Information | |||||||||
| NPI: | 1811329907 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WELCH | ||||||||
| FirstName: | DAVID | ||||||||
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| Mailing Information | |||||||||
| Address1: | 112 KASSON RD | ||||||||
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| City: | CAMILLUS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130312271 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 346 N MIDLER AVE | ||||||||
| Address2: | STE 38 | ||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132062277 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154370325 | ||||||||
| FaxNumber: | 3154370958 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2013 | ||||||||
| LastUpdateDate: | 07/31/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | 14000028288 | NY | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.