Provider Demographics
NPI:1285638650
Name:VILLEGAS, EMILIO (MD)
Entity Type:Individual
Prefix:DR
First Name:EMILIO
Middle Name:
Last Name:VILLEGAS
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 1:100 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:IRWIN
Mailing Address - State:PA
Mailing Address - Zip Code:15642-3552
Mailing Address - Country:US
Mailing Address - Phone:724-863-1204
Mailing Address - Fax:724-863-9169
Practice Address - Street 1:100 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:IRWIN
Practice Address - State:PA
Practice Address - Zip Code:15642-3552
Practice Address - Country:US
Practice Address - Phone:724-863-1204
Practice Address - Fax:724-863-9169
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2009-09-15
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-23
Provider Licenses
StateLicense IDTaxonomies
PA034457L207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0608057Medicaid
580747OtherHIGHMARK
PA0608057Medicaid
580747OtherHIGHMARK