Provider Demographics
NPI:1336179407
Name:VILLAMAYOR, ROSEMARIE C (MD)
Entity Type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:C
Last Name:VILLAMAYOR
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 1:63 N LAKEVIEW DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GIBBSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08026-1026
Mailing Address - Country:US
Mailing Address - Phone:856-783-1777
Mailing Address - Fax:
Practice Address - Street 1:63 N LAKEVIEW DR
Practice Address - Street 2:SUITE 201
Practice Address - City:GIBBSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08026-1026
Practice Address - Country:US
Practice Address - Phone:856-783-1777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07413000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8871701Medicaid
H65877Medicare UPIN
NJ8871701Medicaid