MEDICARE: ROWENA VELILLA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	230245	NY

General Provider Information

NPI Number	:	1376640607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROWENA VELILLA M.D.

Provider Business Mailing Address
First Line	:	JAMESH. QUILLEN/ VAMC
Second Line	:	CORNER OF SIDNEY AND LAMONT ST.
City	:	MOUNTAIN HOME
State	:	TN
Zip	:	37684
Country	:	US
Telephone Number	:	423-979-3573
Fax Number	:	423-979-3401

Provider Business Practice Location Address
First Line	:	2203 LAKELAND DR
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-2018
Country	:	US
Telephone Number	:	423-926-1496
Fax Number	:	423-979-3401

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/08/2007

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