Provider Demographics
NPI:1639503105
Name:KAREN VAN DE VELDE, MD, PC
Entity Type:Organization
Organization Name:KAREN VAN DE VELDE, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:M
Authorized Official - Last Name:VAN DE VELDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-986-5025
Mailing Address - Street 1:2019 GALISTEO ST
Mailing Address - Street 2:SUITE D2
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-2143
Mailing Address - Country:US
Mailing Address - Phone:505-986-5025
Mailing Address - Fax:505-986-3822
Practice Address - Street 1:2019 GALISTEO ST
Practice Address - Street 2:SUITE D2
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-2143
Practice Address - Country:US
Practice Address - Phone:505-986-5025
Practice Address - Fax:505-986-3822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-02
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM94-413207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty