MEDICARE: DR. PAUL M VELLA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	031061	CT

General Provider Information

NPI Number	:	1447263546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL M VELLA M.D.

Provider Business Mailing Address
First Line	:	4 FARM SPRINGS RD
Second Line	:	PROHEALTH PHYSICIANS
City	:	FARMINGTON
State	:	CT
Zip	:	06032-2573
Country	:	US
Telephone Number	:	860-284-5200
Fax Number	:	860-284-5333

Provider Business Practice Location Address
First Line	:	969 HEBRON AVE
Second Line	:
City	:	GLASTONBURY
State	:	CT
Zip	:	06033-2417
Country	:	US
Telephone Number	:	860-633-1131
Fax Number	:	860-633-1636

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	07/08/2007

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