Provider Demographics
NPI:1518939552
Name:BUENAVENTURA, PERCIVAL OFRECIO (MD)
Entity Type:Individual
Prefix:DR
First Name:PERCIVAL
Middle Name:OFRECIO
Last Name:BUENAVENTURA
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 1:220 CAMPUS BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2889
Mailing Address - Country:US
Mailing Address - Phone:540-536-5100
Mailing Address - Fax:540-536-0235
Practice Address - Street 1:1880 AMHERST ST STE 310
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2917
Practice Address - Country:US
Practice Address - Phone:540-536-6721
Practice Address - Fax:540-536-6724
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101279945208G00000X
PAMD048056L174400000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0722375000OtherAMERIHEALTH 65 PA
PA167758OtherUNISON-WMG
PA001488688Medicaid
PA109924OtherJOHNS HOPKINS
PA7490192OtherAETNA
PA143098OtherHIGHMARK BLUE SHIELD
PA1509992OtherGATEWAY-WMG
PA20045780OtherAMERIHEALTH MERCY-WMG
MD645708OtherCAREFIRST MD BCBS
PA58550OtherGEISINGER
PA3140682OtherMAMSI-WMG
PA50050089OtherCAPITAL BLUE CROSS-WMG
PA0722375000OtherAMERIHEALTH 65 PA
PA58550OtherGEISINGER
PA001488688Medicaid