MEDICARE: DR. LEONA ALICE VELICOV DPM

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	213E00000X	Podiatrist	SC001964L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0060668000	OTHER	PA	BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710901244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEONA ALICE VELICOV DPM

Provider Business Mailing Address
First Line	:	3445 ST VINCENT ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19149-1627
Country	:	US
Telephone Number	:	215-338-2444
Fax Number	:	215-708-5000

Provider Business Practice Location Address
First Line	:	3445 ST VINCENT ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19149-1627
Country	:	US
Telephone Number	:	215-338-2444
Fax Number	:	215-708-5000

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

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	04/21/2020

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