Healthcare Provider Details

I. General information

NPI: 1194991760
Provider Name (Legal Business Name): FIDEL VELEZ M D
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2008
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1903 ACHESON AV.
NORTH APOLLO PA
15673-0087
US

IV. Provider business mailing address

PO BOX 87 1903 ACHESON AV.
NORTH APOLLO PA
15673-0087
US

V. Phone/Fax

Practice location:
  • Phone: 724-478-1161
  • Fax:
Mailing address:
  • Phone: 724-478-1161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD041433E
License Number StatePA

VIII. Authorized Official

Name: DR. FIDEL E VELEZ
Title or Position: OWNER
Credential:
Phone: 724-478-1161