Healthcare Provider Details

I. General information

NPI: 1326027822
Provider Name (Legal Business Name): JONATHAN ANDREW VELEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 11/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 SEYMOUR STREET HARTFORD HOSPITAL EMERGENCY MEDICINE
HARTFORD CT
06102-5037
US

IV. Provider business mailing address

PO BOX 415933 HARTFORD HOSPITAL PROFESSIONAL SERVICES
BOSTON MA
02241-5933
US

V. Phone/Fax

Practice location:
  • Phone: 860-545-0000
  • Fax:
Mailing address:
  • Phone: 860-545-7602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number39125
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number051319
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: