Basic Information
| Provider Information | |||||||||
| NPI: | 1821245820 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WELCH | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | NICHOLAS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8018 LINDA ISLE LN | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958315841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5712152680 | ||||||||
| FaxNumber: | 9167344810 | ||||||||
| Practice Location | |||||||||
| Address1: | 4150 V ST STE 3400 | ||||||||
| Address2: | DEPARTMENT OF MEDICINE / SECTION OF HOSPITAL MEDICINE | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958171460 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167347506 | ||||||||
| FaxNumber: | 9167344810 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2008 | ||||||||
| LastUpdateDate: | 11/07/2011 | ||||||||
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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 | 174400000X | MD037322 | DC | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | P00752487 | 01 | DC | RAILROAD MEDICARE | OTHER |