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General NPI Number Information
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NPI Number | 1932169406
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Entity Type | Organization
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Legal Business Name | LOPE T VILLA JR MD PA
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Dates
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Enumeration Date | 03/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 120 SISTER PIERRE DRIVE STE 103
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City | TOWSON
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State | MD
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Zip | 21204
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Country | US
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Telephone | 410-296-4242
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Fax | 410-828-5613
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Provider Business Mailing Address
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Address Line | 120 SISTER PIERRE DRIVE STE 103
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City | TOWSON
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State | MD
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Zip | 21204
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Country | US
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Telephone | 410-296-4242
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Fax | 410-828-5613
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LOPE TAN VILLA JR.
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Credential | MD
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Telephone | 410-296-4242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | D15824
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License Number State | MD
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