Basic Information
Provider Information
NPI: 1306938238
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: VELLODY
FirstName: DEVI
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4500 STUART STREET
Address2: MONCRIEF ARMY COMM HOSP ATTN: MCXL-PQ (CREDENTIALS)
City: FORT JACKSON
State: SC
PostalCode: 292075720
CountryCode: US
TelephoneNumber: 8037512618
FaxNumber: 8037512689
Practice Location
Address1: 4500 STUART ST
Address2: MONCRIEF ARMY COMMUNITY HOSPITAL/CREDENTIALS
City: COLUMBIA
State: SC
PostalCode: 292075700
CountryCode: US
TelephoneNumber: 8037512618
FaxNumber: 8037512689
Other Information
ProviderEnumerationDate: 09/28/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X9124SCY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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