Provider Demographics
NPI:1790762235
Name:VILSECK, JOSEPH R (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:R
Last Name:VILSECK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13510 MIDLOTHIAN TPKE
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-2626
Mailing Address - Country:US
Mailing Address - Phone:804-794-9477
Mailing Address - Fax:804-794-1973
Practice Address - Street 1:13510 MIDLOTHIAN TPKE
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-2626
Practice Address - Country:US
Practice Address - Phone:804-794-9477
Practice Address - Fax:804-794-1973
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-27
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101021733207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB61112Medicare UPIN