Provider Demographics
NPI:1932199353
Name:MAILEY, VICTOR HUGO (MD)
Entity Type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:HUGO
Last Name:MAILEY
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 1:163 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02745-6229
Mailing Address - Country:US
Mailing Address - Phone:508-995-8187
Mailing Address - Fax:508-998-3959
Practice Address - Street 1:163 RIVER RD
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02745-6229
Practice Address - Country:US
Practice Address - Phone:508-995-8187
Practice Address - Fax:508-998-3959
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA51171207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0100942OtherUNITED HEALTHCARE
MA6166334Medicaid
7064OtherHARVARD PILGRIM
MAJ02228OtherBCBS
000000025298OtherBMC HEALTHNET
535737OtherAETNA
B10384701OtherCIGNA
051171OtherTUFTS
0100942OtherUNITED HEALTHCARE
B10384701OtherCIGNA