Provider Demographics
NPI:1477714905
Name:VILLAS, KATINA (MD)
Entity Type:Individual
Prefix:MRS
First Name:KATINA
Middle Name:
Last Name:VILLAS
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 1:4 EXECUTIVE PARK DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-3718
Mailing Address - Country:US
Mailing Address - Phone:518-487-4200
Mailing Address - Fax:518-708-6896
Practice Address - Street 1:4 EXECUTIVE PARK DR
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-3718
Practice Address - Country:US
Practice Address - Phone:518-487-4200
Practice Address - Fax:518-708-6896
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209679-1207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01890940Medicaid
NYG65074Medicare UPIN
NY01890940Medicaid