Provider Demographics
NPI:1255370714
Name:VILLANUEVA, ANGEL L JR (MD)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:L
Last Name:VILLANUEVA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 ELM ST
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:OH
Mailing Address - Zip Code:43140
Mailing Address - Country:US
Mailing Address - Phone:740-506-8596
Mailing Address - Fax:
Practice Address - Street 1:240 ELM STREET
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:OH
Practice Address - Zip Code:43140-1115
Practice Address - Country:US
Practice Address - Phone:740-852-4100
Practice Address - Fax:740-852-3315
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35041340V207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0340590Medicaid
OH0340590Medicaid
VI0437255Medicare PIN