Provider Demographics
NPI:1679596720
Name:VELLA, JOSH C (MD)
Entity Type:Individual
Prefix:
First Name:JOSH
Middle Name:C
Last Name:VELLA
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 1:3200 E CAMELBACK RD
Mailing Address - Street 2:STE 180
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018
Mailing Address - Country:US
Mailing Address - Phone:602-393-4263
Mailing Address - Fax:602-393-2329
Practice Address - Street 1:3200 E CAMELBACK RD
Practice Address - Street 2:STE 180
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-2326
Practice Address - Country:US
Practice Address - Phone:602-393-4263
Practice Address - Fax:602-393-2329
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01061712A207X00000X
AZ36777207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000490593OtherANTHEM
IN200852480Medicaid
IN01061712AOtherSTATE LICENSE
AZ203476Medicaid
IN062110F9Medicare PIN
AZ203476Medicaid
AZZ118555Medicare PIN