Provider Demographics
NPI:1396731097
Name:VELAZQUEZ, LEONARDO JAVIER (MD)
Entity type:Individual
Prefix:DR
First Name:LEONARDO
Middle Name:JAVIER
Last Name:VELAZQUEZ
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 1:1504 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:MA
Mailing Address - Zip Code:01069-1215
Mailing Address - Country:US
Mailing Address - Phone:413-283-3511
Mailing Address - Fax:413-284-4559
Practice Address - Street 1:1504 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:MA
Practice Address - Zip Code:01069-1215
Practice Address - Country:US
Practice Address - Phone:413-283-3511
Practice Address - Fax:413-283-5396
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA223086207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7057674Medicaid
MA2100908Medicaid
RI7057674Medicaid
MAI32080Medicare UPIN
RI007057674Medicare ID - Type Unspecified
MA460458Medicare PIN