Provider Demographics
NPI:1467479428
Name:VILLA, ANNE MARIE F (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNE MARIE
Middle Name:F
Last Name:VILLA
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 1:24 WINTER WAY
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-3952
Mailing Address - Country:US
Mailing Address - Phone:860-749-8995
Mailing Address - Fax:
Practice Address - Street 1:150 HAZARD AVE
Practice Address - Street 2:UNIT B
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-4575
Practice Address - Country:US
Practice Address - Phone:860-749-3661
Practice Address - Fax:860-749-3667
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT034656208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001346560Medicaid
CT001346560Medicaid