Provider Demographics
NPI:1023094646
Name:FABRE, VILMA C (MD)
Entity type:Individual
Prefix:
First Name:VILMA
Middle Name:C
Last Name:FABRE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2211 GREENE WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-4077
Mailing Address - Country:US
Mailing Address - Phone:502-495-1162
Mailing Address - Fax:502-495-0165
Practice Address - Street 1:2211 GREENE WAY
Practice Address - Street 2:STE 100
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-4076
Practice Address - Country:US
Practice Address - Phone:502-495-1162
Practice Address - Fax:502-495-0156
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2020-08-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY26062207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64260623Medicaid
IN200133100Medicaid
KYC73320Medicare UPIN
KY64260623Medicaid