Provider Demographics
NPI:1346299401
Name:VILLANUEVA, DIOSCORO T (MD)
Entity Type:Individual
Prefix:DR
First Name:DIOSCORO
Middle Name:T
Last Name:VILLANUEVA
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 1:1935 ROUTE 70 E
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-2117
Mailing Address - Country:US
Mailing Address - Phone:856-428-7700
Mailing Address - Fax:856-424-9120
Practice Address - Street 1:1935 ROUTE 70 E
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2117
Practice Address - Country:US
Practice Address - Phone:856-428-7700
Practice Address - Fax:856-424-9120
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02781600208600000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1474405Medicaid
NJ1474405Medicaid
NJ447409A7TMedicare PIN