Healthcare Provider Details

I. General information

NPI: 1649692740
Provider Name (Legal Business Name): LAUREN R VELKOFF PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2014
Last Update Date: 01/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 S GOVERNORS AVE STE 101A
DOVER DE
19904-3530
US

IV. Provider business mailing address

830 FOGELMAN RD
MUNCY PA
17756-6811
US

V. Phone/Fax

Practice location:
  • Phone: 302-744-7980
  • Fax:
Mailing address:
  • Phone: 484-639-1476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC5-0000924
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberC5-0000924
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: