Provider Demographics
NPI:1437356565
Name:MEDLERY, VEERESH ANAND (MD)
Entity type:Individual
Prefix:DR
First Name:VEERESH
Middle Name:ANAND
Last Name:MEDLERY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2609 MEDICAL OFFICE PL
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-9428
Mailing Address - Country:US
Mailing Address - Phone:989-681-3524
Mailing Address - Fax:
Practice Address - Street 1:2609 MEDICAL OFFICE PL
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-9428
Practice Address - Country:US
Practice Address - Phone:989-681-3524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301083520207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0802911812OtherBCBSM
MI01012411OtherHEALTHPLUS COMMERCIAL
MI1032406OtherMCLAREN
MI200000017757OtherPHP COMMERCIAL
MI200000017757OtherPHP COMMERCIAL
MIP33470003Medicare PIN