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NPI Code Detail

MEDICARE: VICTOR VIDAL VILLARREAL M.D.

MEDICARE: VICTOR VIDAL VILLARREAL M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist
2208600000XSurgery Physician250056MA

General Provider Information

NPI Number : 1851492714
Entity Type Code : Individual
Provider Name (Legal Business Name) : VICTOR VIDAL VILLARREAL M.D.
Provider Business Mailing Address
First Line : 140 HAVERHILL STREET
Second Line :
City : ANDOVER
State : MA
Zip : 01810-1504
Country : US
Telephone Number : 978-475-4202
Fax Number : 978-475-4393
Provider Business Practice Location Address
First Line : 140 HAVERHILL STREET
Second Line :
City : ANDOVER
State : MA
Zip : 01810-1504
Country : US
Telephone Number : 978-475-4202
Fax Number : 978-475-4393
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/25/2006
Last Update Date : 02/10/2012

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Directions to “ VICTOR VIDAL VILLARREAL M.D.” Practice Location

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