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Individual

RICHARD J VECELLIO

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
119 MARKET PLACE AVE STE D, MOORESVILLE, NC 28117-9157
(704) 801-9140
(704) 801-9141
Mailing address
PO BOX 602148, CHARLOTTE, NC 28260-2148
(704) 801-9140
(704) 801-9141

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
102715
NC
363AM0700X
Medical Physician Assistant
Primary
102715
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1124072301
NC
01
970022547
RR MEDICARE
NC
Enumeration date
05/20/2006
Last updated
05/27/2014
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