Individual
DR. BRENDA RAQUEL VELASCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3401 N BROAD ST, DEPARTMENT OF GASTROENTEROLOGY, TEMPLE UNIVERSITY HOSPI, PHILADELPHIA, PA 19140-5103
(215) 707-3433
Mailing address
301 LIPPINCOTT DR STE 410, MARLTON, NJ 08053-4197
(856) 355-0340
(856) 355-0330
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
25MA08580000
NJ
207RG0100X
Gastroenterology Physician
Primary
25MA08580000
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0196142
—
NJ
Enumeration date
07/01/2008
Last updated
10/09/2024
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