Provider Demographics
NPI:1922093590
Name:VELASCO, NOEL (MD)
Entity Type:Individual
Prefix:
First Name:NOEL
Middle Name:
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 1:1 CORPORATE DR STE 325
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-6295
Mailing Address - Country:US
Mailing Address - Phone:203-696-6125
Mailing Address - Fax:203-337-9731
Practice Address - Street 1:1 CORPORATE DR STE 325
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-6295
Practice Address - Country:US
Practice Address - Phone:203-696-6125
Practice Address - Fax:203-337-9731
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT391312085R0204X
CT0391312085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001391317-P1OtherBLUE CARE FAMILY PLAN
CT300124894OtherRAILROAD MEDICARE
CT500HBX051CT01OtherBLUE CARE FAMILY PLAN
CT2069098OtherUNITED HEALTHCARE
CTANC1162OtherOXFORD HEALTH PLANS
CT001391317Medicaid
CT0086989OtherAETNA CT
CT061613357OtherCIGNA CT
CT500HBX051CT01OtherBCBS CT
CTOV9113OtherHEALTH NET
H15580Medicare UPIN
CT300003086Medicare ID - Type Unspecified