Healthcare Provider Details

I. General information

NPI: 1124550611
Provider Name (Legal Business Name): KAVYA VELUVOLU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 07/07/2021
Certification Date: 07/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 EASTERN AVENUE MFL BLDG, TOWER 2, SUITE 2200
BALTIMORE MD
21224-2734
US

IV. Provider business mailing address

6201 GREENLEIGH AVE
BALTIMORE MD
21220-2004
US

V. Phone/Fax

Practice location:
  • Phone: 410-550-0925
  • Fax: 410-550-0182
Mailing address:
  • Phone: 410-933-6423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberD91319
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: