Provider Demographics
NPI:1851507263
Name:VILLA, KATHRYN JOCKOVIC (MD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:JOCKOVIC
Last Name:VILLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:JOCKOVIC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 7308
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22207-0308
Mailing Address - Country:US
Mailing Address - Phone:800-292-1387
Mailing Address - Fax:502-456-4440
Practice Address - Street 1:1625 N GEORGE MASON DR
Practice Address - Street 2:PATHOLOGY DEPT
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3683
Practice Address - Country:US
Practice Address - Phone:703-558-6566
Practice Address - Fax:502-456-4440
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101251315207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC057000700Medicaid
MD1022-0011OtherCAREFIRST BC/BS
MD0453382 01Medicaid
VAP01185683OtherMEDICARE RR
VA1851507263Medicaid
VAP01185683OtherMEDICARE RR