Provider Demographics
NPI:1790740199
Name:VILLAROMAN, PRISCILLA A (MD)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:A
Last Name:VILLAROMAN
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:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:825 BARRET AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204-1743
Practice Address - Country:US
Practice Address - Phone:502-540-7200
Practice Address - Fax:502-540-7207
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01046413A207R00000X
KY37986207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000023033COtherHUMANA- NORTON
IN2447469000OtherPASSPORT ADVAN-N ALBANY
3315960000OtherPASSOPRT ADVANTAGE / NMCA BARRET
50006201OtherPASSPORT / NCMA NEW ALBANY
IN1204806OtherCHA- NORTON
KY7100009560Medicaid
IN50016180OtherPASSPORT- BARRET AVENORT
KYP00410683OtherRAILROAD MEDICARE
KY1361920OtherMEDICARE
IN200153800Medicaid
IN007048OtherSIHO- NORTON
IN1902282OtherCIGNA- NORTON
2447469000OtherPASSPORT ADVANTAGE / NCMA NEW ALBANY
IN200153800OtherMD WISE- NORTON
IN000000300133OtherANTHEM- NORTON
INP00021727OtherRAILROAD MEDICARE
IN000000300133OtherANTHEM- NORTON
INP00021727OtherRAILROAD MEDICARE