Healthcare Provider Details

I. General information

NPI: 1962767541
Provider Name (Legal Business Name): GISELA VELEZ, M.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 07/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 GROTON RD SUITE 240
AYER MA
01432-1124
US

IV. Provider business mailing address

190 GROTON RD SUITE 240
AYER MA
01432-1191
US

V. Phone/Fax

Practice location:
  • Phone: 978-772-4000
  • Fax: 978-772-3066
Mailing address:
  • Phone: 978-772-4000
  • Fax: 978-772-3066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number210293
License Number StateMA

VIII. Authorized Official

Name: DR. GISELA V ELEZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 978-772-4000