Healthcare Provider Details

I. General information

NPI: 1265571459
Provider Name (Legal Business Name): ANGELA VELOUDIOS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 CIVIC CENTER BLVD WEST PAVILION, 3RD FLOOR
PHILADELPHIA PA
19104-5127
US

IV. Provider business mailing address

51 N 39TH ST
PHILADELPHIA PA
19104-9104
US

V. Phone/Fax

Practice location:
  • Phone: 215-614-4100
  • Fax: 215-615-0527
Mailing address:
  • Phone: 215-614-4100
  • Fax: 215-615-0527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number25MA05527500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD034232E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: