Provider Demographics
NPI:1417003443
Name:VELASQUEZ, ROLANDO (MD)
Entity Type:Individual
Prefix:DR
First Name:ROLANDO
Middle Name:
Last Name:VELASQUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 ROLLINGWOOD ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-1854
Mailing Address - Country:US
Mailing Address - Phone:716-689-8038
Mailing Address - Fax:
Practice Address - Street 1:425 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-2209
Practice Address - Country:US
Practice Address - Phone:716-848-2180
Practice Address - Fax:716-848-2125
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY110087207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV70198Medicare ID - Type Unspecified
NYB35961Medicare UPIN