Provider Demographics
NPI:1700878790
Name:VILLAFUERTE, PABLO D (MD)
Entity Type:Individual
Prefix:MR
First Name:PABLO
Middle Name:D
Last Name:VILLAFUERTE
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1400 DELAWARE AVE
Mailing Address - Street 2:STE 1-A
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-3089
Mailing Address - Country:US
Mailing Address - Phone:302-655-0188
Mailing Address - Fax:302-655-0286
Practice Address - Street 1:1400 DELAWARE AVE
Practice Address - Street 2:STE 1-A
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-3089
Practice Address - Country:US
Practice Address - Phone:302-655-0188
Practice Address - Fax:302-655-0286
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0D007892084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000449501Medicaid
DE0000449501Medicaid
B66549Medicare UPIN