Provider Demographics
NPI:1558750216
Name:VILLAR, MARIA MERCEDES (RD LDN)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:MERCEDES
Last Name:VILLAR
Suffix:
Gender:F
Credentials:RD LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 CENTRAL AVENUE
Mailing Address - Street 2:PHYSICIANS OFFICE BUILDING SUITE 210
Mailing Address - City:PHILADEPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-1609
Mailing Address - Country:US
Mailing Address - Phone:215-722-3258
Mailing Address - Fax:
Practice Address - Street 1:7500 CENTRAL AVENUE
Practice Address - Street 2:PHYSICIANS OFFICE BUILDING SUITE 210
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111
Practice Address - Country:US
Practice Address - Phone:215-722-3258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-20
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered