Healthcare Provider Details

I. General information

NPI: 1265095160
Provider Name (Legal Business Name): MARCOS DANIEL VILLARREAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2019
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 SAM PERRY BLVD STE 305
FREDERICKSBURG VA
22401-4465
US

IV. Provider business mailing address

1500 RED RIVER ST UT AUSTIN DELL MEDICAL SCHOOL SETON INTERNAL MEDICINE
AUSTIN TX
78701-1918
US

V. Phone/Fax

Practice location:
  • Phone: 540-374-3290
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35091
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101284157
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberBP10067181
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberC1-0028811
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: