Provider Demographics
NPI:1821403478
Name:WELDO N, VIRGINIA VERRAL (MD)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:VERRAL
Last Name:WELDO N
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:VIRGINIA
Other - Middle Name:VERRAL
Other - Last Name:WELDON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:242 CARLYLE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7544
Mailing Address - Country:US
Mailing Address - Phone:314-432-0504
Mailing Address - Fax:314-692-7793
Practice Address - Street 1:242 CARLYLE LAKE DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-7544
Practice Address - Country:US
Practice Address - Phone:314-432-0504
Practice Address - Fax:314-692-7793
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3290174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist