Provider Demographics
NPI:1730189747
Name:VELAZQUEZ, NELSON E (DO)
Entity type:Individual
Prefix:MR
First Name:NELSON
Middle Name:E
Last Name:VELAZQUEZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:148 LINDEN DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-6909
Mailing Address - Country:US
Mailing Address - Phone:540-504-0066
Mailing Address - Fax:540-678-9025
Practice Address - Street 1:94 BROOKSHIRE LANE
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-6765
Practice Address - Country:US
Practice Address - Phone:304-252-2673
Practice Address - Fax:304-929-2350
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1500207N00000X, 207NP0225X, 207NS0135X, 207ND0101X
MDH82265207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0070083000Medicaid
MD584137200Medicaid
MD553225ZX9BMedicare PIN
E83017Medicare UPIN
WV0070083000Medicaid