Provider Demographics
NPI:1043206527
Name:VELAZQUEZ-MCGUIRK, ELSA (MD)
Entity Type:Individual
Prefix:
First Name:ELSA
Middle Name:
Last Name:VELAZQUEZ-MCGUIRK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 FRONTIER DR
Mailing Address - Street 2:
Mailing Address - City:WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02081-5010
Mailing Address - Country:US
Mailing Address - Phone:917-837-8445
Mailing Address - Fax:
Practice Address - Street 1:15 CRAWFORD ST STE 100
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-2618
Practice Address - Country:US
Practice Address - Phone:617-969-4100
Practice Address - Fax:617-969-3393
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001708207ND0900X
MA229776207ZD0900X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH77337Medicare UPIN