Provider Demographics
NPI:1235172511
Name:VANDER VELDE, NANCY S (MD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:S
Last Name:VANDER VELDE
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 1:1601 PERDIDO ST
Mailing Address - Street 2:ATTN: MEDICINE OFFICE
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-1262
Mailing Address - Country:US
Mailing Address - Phone:504-553-2143
Mailing Address - Fax:504-553-2113
Practice Address - Street 1:1601 PERDIDO ST
Practice Address - Street 2:ATTN: MEDICINE OFFICE
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-1262
Practice Address - Country:US
Practice Address - Phone:504-553-2143
Practice Address - Fax:504-553-2113
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD58947207R00000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD377201200Medicaid
MDP00136883OtherR/R MEDICARE PROVIDER #
MDC31152OtherR/R MEDICARE GROUP #
MDH68501Medicare UPIN
MDP00136883OtherR/R MEDICARE PROVIDER #