Provider Demographics
NPI:1790775930
Name:VILLAMENA, PATRICIA C (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:C
Last Name:VILLAMENA
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:P.O. BOX 95000-2433
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-2433
Mailing Address - Country:US
Mailing Address - Phone:212-420-2377
Mailing Address - Fax:212-420-4684
Practice Address - Street 1:10 UNION SQUARE EAST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3314
Practice Address - Country:US
Practice Address - Phone:212-420-2377
Practice Address - Fax:212-420-4684
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY137310207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01147373Medicaid
B19300Medicare UPIN
NY77D201Medicare ID - Type Unspecified
NYB19300Medicare UPIN