Active NPI
Vilma Fondevilla Tadalan-Velasco, M.D.
- Pediatrics Physician
- North East, MD
National Provider Identifier
1194055871
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- D0014635
- Practice address
- 80 Kirks Mill LN
North East, MD 21901-1712 - Phone
- (702) 430-8881
- NPI assigned
- Jan 3, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | D0014635 | MD | Primary |
Addresses
Primary practice location
80 Kirks Mill LN
North East, MD 21901-1712
Mailing address
80 Kirks Mill LN
North East, MD 21901-1712
Phone (702) 430-8881
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D0014635 | MD | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1262476800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1262476800000",
"number": "1194055871",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "80 KIRKS MILL LN",
"city": "NORTH EAST",
"state": "MD",
"postal_code": "219011712",
"telephone_number": "702-430-8881"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "80 KIRKS MILL LN",
"city": "NORTH EAST",
"state": "MD",
"postal_code": "219011712",
"telephone_number": "702-430-8881"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TADALAN-VELASCO",
"first_name": "VILMA",
"middle_name": "FONDEVILLA",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-01-03",
"last_updated": "2010-01-03",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MD",
"license": "D0014635",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North East, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.