Provider Demographics
NPI:1871634709
Name:VELAZ-FAIRCLOTH, MARIA E (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:E
Last Name:VELAZ-FAIRCLOTH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 SHADY LAWN ROAD EXT
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-2014
Mailing Address - Country:US
Mailing Address - Phone:919-968-3965
Mailing Address - Fax:
Practice Address - Street 1:414 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27701-3720
Practice Address - Country:US
Practice Address - Phone:919-560-7658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103255363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical