Provider Demographics
NPI:1275501645
Name:AVILES, VICTOR M (MD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:M
Last Name:AVILES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:26 EDGERTON DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:NORTH FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02556-2820
Mailing Address - Country:US
Mailing Address - Phone:508-564-7411
Mailing Address - Fax:508-564-7431
Practice Address - Street 1:26 EDGERTON DR
Practice Address - Street 2:SUITE A
Practice Address - City:NORTH FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02556-2820
Practice Address - Country:US
Practice Address - Phone:508-564-7411
Practice Address - Fax:508-564-7431
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA210733207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1616080Medicaid
MA14708OtherHPHC
MAJ24050OtherBCBS
A32885Medicare ID - Type Unspecified
MAJ24050OtherBCBS