Provider Demographics
NPI:1396862678
Name:DEL VILLAR, GEORGE (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:DEL VILLAR
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 1:475 MAITLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-5444
Mailing Address - Country:US
Mailing Address - Phone:407-647-2009
Mailing Address - Fax:407-660-2009
Practice Address - Street 1:475 MAITLAND AVE
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-5444
Practice Address - Country:US
Practice Address - Phone:407-647-2009
Practice Address - Fax:407-660-2009
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99610208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02625327Medicaid
FL53228OtherBLUE CROSS IDENTIFIER
FL53228OtherBLUE CROSS IDENTIFIER
NYI22769Medicare UPIN
NY524271Medicare ID - Type Unspecified
FL5377960004Medicare NSC
FLAK826YMedicare PIN
FLAK826UMedicare PIN