Provider Demographics
NPI:1205853728
Name:VILASI, VINCENT J (MD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:J
Last Name:VILASI
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 1:1800 JONATHAN WAY APT 407
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-3678
Mailing Address - Country:US
Mailing Address - Phone:703-980-4187
Mailing Address - Fax:
Practice Address - Street 1:1500 FOREST GLEN RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-1460
Practice Address - Country:US
Practice Address - Phone:703-980-4187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD74826207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA050053985OtherRAILROAD MEDICARE
VA071322OtherANTHEM
VA1205853728Medicaid
DCK142-0001OtherCAREFIRST
VA297170OtherAMERIGROUP
VA493821OtherNCPPO
VAF15326Medicare UPIN
VA071322OtherANTHEM
VA00W148F01Medicare PIN