Provider Demographics
NPI:1922325919
Name:PEDIATRIC GASTROENTEROLOGY OF RICHMOND, P.C.
Entity Type:Organization
Organization Name:PEDIATRIC GASTROENTEROLOGY OF RICHMOND, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLALONA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-888-7337
Mailing Address - Street 1:7229 FOREST AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-3765
Mailing Address - Country:US
Mailing Address - Phone:804-888-7337
Mailing Address - Fax:
Practice Address - Street 1:7229 FOREST AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-3765
Practice Address - Country:US
Practice Address - Phone:804-888-7337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric GastroenterologyGroup - Single Specialty