Provider Demographics
NPI:1497717342
Name:MARANA, ENRIQUE VILLA (MD)
Entity Type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:VILLA
Last Name:MARANA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RICARDO
Other - Middle Name:ENRIQUE
Other - Last Name:MARANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3485 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27828-1466
Mailing Address - Country:US
Mailing Address - Phone:252-753-3193
Mailing Address - Fax:252-753-7966
Practice Address - Street 1:3485 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:NC
Practice Address - Zip Code:27828-1466
Practice Address - Country:US
Practice Address - Phone:252-753-3193
Practice Address - Fax:252-753-7966
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200000090207RA0000X
NC20000090207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89126A3Medicaid
NC126A3OtherBLUE CROSS BLUE SHIELD
NCP00379704OtherRAILROAD MEDICARE
NCH16338Medicare UPIN
NC2280338BMedicare PIN