Provider Demographics
NPI:1326024779
Name:VILLACORTA, RODOLFO (MD)
Entity Type:Individual
Prefix:
First Name:RODOLFO
Middle Name:
Last Name:VILLACORTA
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 1:1026 UNION RD
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-3449
Mailing Address - Country:US
Mailing Address - Phone:716-712-0851
Mailing Address - Fax:716-712-0852
Practice Address - Street 1:1026 UNION RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3449
Practice Address - Country:US
Practice Address - Phone:716-712-0851
Practice Address - Fax:716-712-0852
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103354207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000504942005OtherBC/BS
NY0407881OtherIHA
NY398495OtherWELLCARE
NY00010184203OtherUNIVERA
NY00682462Medicaid
NY00682462Medicaid
NYDD4989Medicare PIN
NY00010184203OtherUNIVERA