Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | D 00 63900 | MD |
NPI | 1053381202 |
---|---|
Provider Name | Dr. Gary A Vela |
First Address | Columbia, MD 21045-1982 |
Second Address | Columbia, MD 21045-1982 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2006 |
Last Update Date | 08/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7269001 | BLUE CROSS BLUE SHIELD (01) | MD |
I07162 | (02) | MD |