Provider Demographics
NPI:1710901244
Name:VELICOV, LEONA ALICE (DPM)
Entity Type:Individual
Prefix:DR
First Name:LEONA
Middle Name:ALICE
Last Name:VELICOV
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:LEONA
Other - Middle Name:ALICE
Other - Last Name:VELICOV
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:3445 ST VINCENT ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19149-1627
Mailing Address - Country:US
Mailing Address - Phone:215-338-2444
Mailing Address - Fax:215-708-5000
Practice Address - Street 1:3445 ST VINCENT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-1627
Practice Address - Country:US
Practice Address - Phone:215-338-2444
Practice Address - Fax:215-708-5000
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC001964L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0060668000OtherBLUE SHIELD
PA007047608-0006Medicaid
PA007047608-0004Medicaid
PA007047608-0005Medicaid
PA007047608-0008Medicaid
PA007047608-0009Medicaid