Provider Demographics
NPI:1629069182
Name:VELLAH, PREACHESS (MD)
Entity Type:Individual
Prefix:
First Name:PREACHESS
Middle Name:
Last Name:VELLAH
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 1:36377 TARPON DRIVE
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-5056
Mailing Address - Country:US
Mailing Address - Phone:302-645-2245
Mailing Address - Fax:
Practice Address - Street 1:36377 TARPON DRIVE
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-5056
Practice Address - Country:US
Practice Address - Phone:302-645-2245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10007190207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000030582Medicaid
DE1000030582Medicaid
015466D42Medicare ID - Type Unspecified