Provider Demographics
NPI:1447390455
Name:VELAS, CARLOS M (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:M
Last Name:VELAS
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 1:307 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1775
Mailing Address - Country:US
Mailing Address - Phone:610-849-2291
Mailing Address - Fax:610-419-3046
Practice Address - Street 1:865 E 4TH ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015-1935
Practice Address - Country:US
Practice Address - Phone:610-691-4357
Practice Address - Fax:484-221-9130
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030940-E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010072940007Medicaid
PA027069OtherGATEWAY
PAC27864OtherAMERIHEALTH
PAC27864OtherMAGELLAN BEHAVIORAL HEALT
PA0010072940007Medicaid
PAC27864Medicare UPIN