Basic Information
| Provider Information | |||||||||
| NPI: | 1578513560 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VELARDE | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1605 N CEDAR CREST BLVD | ||||||||
| Address2: | SUITE 110B | ||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181042351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109731410 | ||||||||
| FaxNumber: | 6109731449 | ||||||||
| Practice Location | |||||||||
| Address1: | 6081 HAMILTON BLVD STE 101 | ||||||||
| Address2: | |||||||||
| City: | WESCOSVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181069801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103950600 | ||||||||
| FaxNumber: | 4844034018 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2006 | ||||||||
| LastUpdateDate: | 10/04/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD063905L | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00221679 | 01 | PA | PALMETTO GBA MEDICARE | OTHER | 1521387 | 01 | PA | GATEWAY HEALTH PLAN | OTHER | 50046210 | 01 | PA | CAPITAL BLUE CROSS | OTHER | 682317 | 01 | PA | HIGHMARK PA BLUE SHIELD | OTHER |