Provider Demographics
NPI:1528094844
Name:VELAZQUEZ, GRETCHEN YAZMINE (MD)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:YAZMINE
Last Name:VELAZQUEZ
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 1:4510 PREMIER DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-8349
Mailing Address - Country:US
Mailing Address - Phone:336-905-6333
Mailing Address - Fax:336-905-6334
Practice Address - Street 1:4510 PREMIER DR
Practice Address - Street 2:SUITE 101
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-8349
Practice Address - Country:US
Practice Address - Phone:336-905-6333
Practice Address - Fax:336-905-6334
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2003-00101207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1212660010OtherDME
NC89137K8Medicaid
NCP00154395OtherRR MEDICARE
NC2031426BMedicare PIN
NC89137K8Medicaid
NC2031426Medicare PIN
I13606Medicare UPIN