Provider Demographics
NPI:1437178431
Name:VILL, MAGGIE D (MD)
Entity Type:Individual
Prefix:DR
First Name:MAGGIE
Middle Name:D
Last Name:VILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1415 PORTLAND AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-3038
Mailing Address - Country:US
Mailing Address - Phone:585-922-4200
Mailing Address - Fax:585-922-4922
Practice Address - Street 1:1415 PORTLAND AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3038
Practice Address - Country:US
Practice Address - Phone:585-922-4200
Practice Address - Fax:585-922-4922
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY178771207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01456591Medicaid
NY01456591Medicaid
NYRA9079Medicare PIN