Provider Demographics
NPI:1124419916
Name:PATINO-VELASQUEZ, SKARLET W (MD)
Entity type:Individual
Prefix:DR
First Name:SKARLET
Middle Name:W
Last Name:PATINO-VELASQUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2022 OPITZ BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3323
Mailing Address - Country:US
Mailing Address - Phone:571-398-2341
Mailing Address - Fax:571-398-6388
Practice Address - Street 1:2022 OPITZ BLVD STE B
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3323
Practice Address - Country:US
Practice Address - Phone:571-398-2341
Practice Address - Fax:571-398-6388
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-15
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19350207R00000X, 207RC0000X, 390200000X
VA0101277163207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program