Provider Demographics
NPI:1376640607
Name:VELILLA, ROWENA (MD)
Entity Type:Individual
Prefix:
First Name:ROWENA
Middle Name:
Last Name:VELILLA
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:JAMESH. QUILLEN/ VAMC
Mailing Address - Street 2:CORNER OF SIDNEY AND LAMONT ST.
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:TN
Mailing Address - Zip Code:37684
Mailing Address - Country:US
Mailing Address - Phone:423-979-3573
Mailing Address - Fax:423-979-3401
Practice Address - Street 1:2203 LAKELAND DR
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-2018
Practice Address - Country:US
Practice Address - Phone:423-926-1496
Practice Address - Fax:423-979-3401
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY230245207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology