Provider Demographics
NPI:1336101989
Name:VILLANUEVA, EMMA CALDERON (MD)
Entity Type:Individual
Prefix:DR
First Name:EMMA
Middle Name:CALDERON
Last Name:VILLANUEVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 HARPER RD
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-3310
Mailing Address - Country:US
Mailing Address - Phone:304-252-8531
Mailing Address - Fax:304-252-0466
Practice Address - Street 1:1602 HARPER RD
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3310
Practice Address - Country:US
Practice Address - Phone:304-252-8531
Practice Address - Fax:304-252-0466
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV12014208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0021384-000Medicaid
WVVIO886041Medicare UPIN
WVBE9263681Medicare ID - Type UnspecifiedGROUP