Provider Demographics
NPI:1811217649
Name:VELASCO, ROBERT Y (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:Y
Last Name:VELASCO
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 1:375 WAMPANOAG TRAIL
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02915
Mailing Address - Country:US
Mailing Address - Phone:401-649-4050
Mailing Address - Fax:401-649-4051
Practice Address - Street 1:375 WAMPANOAG TRAIL
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02915
Practice Address - Country:US
Practice Address - Phone:401-649-4050
Practice Address - Fax:401-649-4051
Is Sole Proprietor?:No
Enumeration Date:2010-06-03
Last Update Date:2017-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD14253207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine