Healthcare Provider Details

I. General information

NPI: 1417003443
Provider Name (Legal Business Name): ROLANDO VELASQUEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 MICHIGAN AVE
BUFFALO NY
14203-2209
US

IV. Provider business mailing address

160 ROLLINGWOOD ST
WILLIAMSVILLE NY
14221-1854
US

V. Phone/Fax

Practice location:
  • Phone: 716-848-2180
  • Fax: 716-848-2125
Mailing address:
  • Phone: 716-689-8038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number110087
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: