Healthcare Provider Details

I. General information

NPI: 1912298233
Provider Name (Legal Business Name): RAMON CHRISTOPHER VILLANUEVA GO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2011
Last Update Date: 05/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 ANNAPOLIS RD STE 100
ODENTON MD
21113-1622
US

IV. Provider business mailing address

1130 ANNAPOLIS RD STE 100
ODENTON MD
21113-1622
US

V. Phone/Fax

Practice location:
  • Phone: 410-672-2255
  • Fax: 410-672-2275
Mailing address:
  • Phone: 410-672-2255
  • Fax: 410-672-2275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number279377
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number279377
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: