Provider Demographics
NPI:1164408613
Name:SIMOES DE CARVALHO, VICTOR LUIS (MD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:LUIS
Last Name:SIMOES DE CARVALHO
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 1:579A CRANBURY RD
Mailing Address - Street 2:UNIVERSITY RADIOLOGY GROUP PC
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-5426
Mailing Address - Country:US
Mailing Address - Phone:732-390-0040
Mailing Address - Fax:732-390-1856
Practice Address - Street 1:579A CRANBURY RD
Practice Address - Street 2:UNIVERSITY RADIOLOGY GROUP PC
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-5426
Practice Address - Country:US
Practice Address - Phone:732-390-0040
Practice Address - Fax:732-390-1856
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA067341002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7584202Medicaid
NY02206077Medicaid
NJ009355RAYMedicare PIN
NY02206077Medicaid
G05100Medicare UPIN