Healthcare Provider Details

I. General information

NPI: 1497980361
Provider Name (Legal Business Name): MARCELLA VILLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2009
Last Update Date: 07/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 N BEAUREGARD ST SUITE 200
ALEXANDRIA VA
22311-1723
US

IV. Provider business mailing address

1500 N BEAUREGARD ST SUITE 200
ALEXANDRIA VA
22311-1723
US

V. Phone/Fax

Practice location:
  • Phone: 703-212-6600
  • Fax:
Mailing address:
  • Phone: 703-212-6600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101251737
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: