Provider Demographics
NPI:1659445740
Name:VILLENEUVE, DEBORAH L (MD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:L
Last Name:VILLENEUVE
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 1:1013 BROOKSIDE RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18106-9598
Mailing Address - Country:US
Mailing Address - Phone:610-657-1266
Mailing Address - Fax:610-841-5001
Practice Address - Street 1:1013 BROOKSIDE RD
Practice Address - Street 2:SUITE 110
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18106-9598
Practice Address - Country:US
Practice Address - Phone:610-657-1266
Practice Address - Fax:610-841-5001
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD054639L207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01435902OtherCAPITAL BLUE CROSS
PA2718521OtherAETNA
PA039435OtherBLUE SHIELD
PA0686580000OtherKEYSTONE EAST
PA2718521OtherAETNA
PA01435902OtherCAPITAL BLUE CROSS