Provider Demographics
NPI:1932169406
Name:LOPE T VILLA JR MD PA
Entity Type:Organization
Organization Name:LOPE T VILLA JR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOPE
Authorized Official - Middle Name:TAN
Authorized Official - Last Name:VILLA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:410-296-4242
Mailing Address - Street 1:120 SISTER PIERRE DRIVE
Mailing Address - Street 2:STE 103
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204
Mailing Address - Country:US
Mailing Address - Phone:410-296-4242
Mailing Address - Fax:410-828-5613
Practice Address - Street 1:120 SISTER PIERRE DRIVE
Practice Address - Street 2:STE 103
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204
Practice Address - Country:US
Practice Address - Phone:410-296-4242
Practice Address - Fax:410-828-5613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD15824208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C57665Medicare UPIN
8775LTMedicare ID - Type Unspecified