Provider Demographics
NPI:1508062217
Name:VECCHIARELLI, ANTHONY JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:JOHN
Last Name:VECCHIARELLI
Suffix:
Gender:M
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 1:7610 N UNION BLVD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-3891
Mailing Address - Country:US
Mailing Address - Phone:719-550-5180
Mailing Address - Fax:719-434-3077
Practice Address - Street 1:7610 N UNION BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3891
Practice Address - Country:US
Practice Address - Phone:719-550-5180
Practice Address - Fax:719-434-3077
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO31061207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO74018Medicare ID - Type Unspecified
COE73665Medicare UPIN