Provider Demographics
NPI:1417938705
Name:VILLAMIL, CARLOS F (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:F
Last Name:VILLAMIL
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 1:460 TOTTEN POND RD
Mailing Address - Street 2:C O MZI
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-1906
Mailing Address - Country:US
Mailing Address - Phone:781-890-9933
Mailing Address - Fax:781-890-9950
Practice Address - Street 1:1 CRANBERRY HL STE 303
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-7397
Practice Address - Country:US
Practice Address - Phone:781-290-0057
Practice Address - Fax:781-290-0059
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA152633207ZC0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ21067OtherBCBS
MAA29324Medicare ID - Type Unspecified
G89412Medicare UPIN