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General NPI Number Information
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NPI Number | 1497717342
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Entity Type | Individual
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Provider Name | ENRIQUE VILLA MARANA MD
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Gender | Male
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Dates
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Enumeration Date | 04/05/2006
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Last Update Date | 02/17/2010
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Provider Practice Location Address
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Address Line | 3485 N MAIN ST
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City | FARMVILLE
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State | NC
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Zip | 27828-1466
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Country | US
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Telephone | 252-753-3193
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Fax | 252-753-7966
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Provider Business Mailing Address
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Address Line | 3485 N MAIN ST
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City | FARMVILLE
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State | NC
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Zip | 27828-1466
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Country | US
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Telephone | 252-753-3193
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Fax | 252-753-7966
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RA0000X
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Taxonomy Name | Adolescent Medicine (Internal Medicine) Physician
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License Number | 200000090
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 20000090
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License Number State | NC
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