Provider Demographics
NPI:1700889953
Name:VILLANUEVA, ROMULO G (MD)
Entity Type:Individual
Prefix:DR
First Name:ROMULO
Middle Name:G
Last Name:VILLANUEVA
Suffix:
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 1:1036 RICHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-1925
Mailing Address - Country:US
Mailing Address - Phone:301-777-7846
Mailing Address - Fax:
Practice Address - Street 1:913 SETON DR
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-1817
Practice Address - Country:US
Practice Address - Phone:301-759-2555
Practice Address - Fax:301-759-2557
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0021872174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD21872Medicare UPIN
MD8935RGMedicare ID - Type Unspecified