Provider Demographics
NPI:1124012273
Name:VILLARE, ROBERT C (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:C
Last Name:VILLARE
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 1:113 WESTWOOD HILL
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-1178
Mailing Address - Country:US
Mailing Address - Phone:856-848-4131
Mailing Address - Fax:
Practice Address - Street 1:113 WESTWOOD HILL
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-1178
Practice Address - Country:US
Practice Address - Phone:856-848-4131
Practice Address - Fax:856-848-4131
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-06
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039406L2083A0100X, 208600000X, 2086S0129X, 208G00000X
NJ25MA04703400208600000X, 2086S0129X, 208G00000X
DEC10005653208600000X, 2086S0129X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000002081Medicaid
DE1000002081Medicaid
NJ542866Medicare ID - Type Unspecified
B96854Medicare UPIN
DE490542Medicare ID - Type Unspecified