Provider Demographics
NPI:1780242644
Name:VELEZ, HANNAH LUCILLE (DO)
Entity type:Individual
Prefix:DR
First Name:HANNAH
Middle Name:LUCILLE
Last Name:VELEZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:517 SOUTH ST
Practice Address - Street 2:
Practice Address - City:LYKENS
Practice Address - State:PA
Practice Address - Zip Code:17048-1520
Practice Address - Country:US
Practice Address - Phone:717-453-1079
Practice Address - Fax:717-453-8292
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-04
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS022621207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2R2950OtherMEDICARE
PA1041450270001Medicaid