Provider Demographics
NPI:1275510786
Name:VELARDE, REGINA A (MD)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:A
Last Name:VELARDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1662 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-4001
Mailing Address - Country:US
Mailing Address - Phone:518-869-9692
Mailing Address - Fax:518-869-7220
Practice Address - Street 1:1662 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-4001
Practice Address - Country:US
Practice Address - Phone:518-869-9692
Practice Address - Fax:518-869-7220
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207499207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000401039003OtherBLUE SHIELD OF NENY
000401039002OtherBLUE SHIELD OF NENY
141659448OtherUNITED HEALTH CARE
7425318OtherAETNA
364852OtherMVP
141752151OtherUNITED HEALTH CARE
364850OtherMVP
364851OtherMVP
000401039004OtherBLUE SHIELD OF NENY
141752151OtherSTATEWIDE PPO
2591584OtherGHI
196AD1OtherBLUE CROSS BLUE SHIELD
72703OtherGHI HMO
10022828OtherCDPHP
141659448OtherSTATEWIDE PPO
196AC1OtherBLUE CROSS BLUE SHIELD
196AC2OtherBLUE CROSS BLUE SHIELD
196AC2OtherBLUE CROSS BLUE SHIELD
196AD1OtherBLUE CROSS BLUE SHIELD
364851OtherMVP