Healthcare Provider Details

I. General information

NPI: 1275578049
Provider Name (Legal Business Name): PATRICIA VELOSO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 09/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1068 WEST BALTIMORE PIKE
MEDIA PA
19063-5177
US

IV. Provider business mailing address

PO BOX 414853
BOSTON MA
02241-4853
US

V. Phone/Fax

Practice location:
  • Phone: 610-891-3229
  • Fax: 610-627-4297
Mailing address:
  • Phone: 706-650-0705
  • Fax: 706-650-1034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD421888
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberD61690
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: