Provider Demographics
NPI:1083703847
Name:VELOTTI, THOMAS LOUIS (DPM)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:LOUIS
Last Name:VELOTTI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 306 NORTH STREET
Mailing Address - Street 2:SUITE 2 NORTH STREET PROFESSIONAL PLAZA
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921
Mailing Address - Country:US
Mailing Address - Phone:410-398-6009
Mailing Address - Fax:410-398-6088
Practice Address - Street 1:304 306 NORTH STREET
Practice Address - Street 2:SUITE 2 NORTH STREET PROFESSIONAL PLAZA
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921
Practice Address - Country:US
Practice Address - Phone:410-398-6009
Practice Address - Fax:410-398-6088
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002792L213E00000X
MD00896213E00000X
DEEI0000174213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD438498900Medicaid
PA7093736Medicaid
PA533646Medicare ID - Type Unspecified
MDT234Medicare ID - Type Unspecified
DE491993Medicare ID - Type Unspecified
MD438498900Medicaid
PA7093736Medicaid
MD5331930001Medicare NSC