MEDICARE: MINERVA VILLAFANE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0804X	Child & Adolescent Psychiatry Physician	MD439863	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073587895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MINERVA VILLAFANE MD

Provider Business Mailing Address
First Line	:	1428 CANDLEWYCKE DR
Second Line	:
City	:	MIDDLETOWN
State	:	PA
Zip	:	17057-2900
Country	:	US
Telephone Number	:	478-320-6269
Fax Number	:	717-939-2503

Provider Business Practice Location Address
First Line	:	PATHWAYS CENTER
Second Line	:	122-C GORDON COMMERCIAL DR
City	:	LAGRANGE
State	:	GA
Zip	:	30240-5754
Country	:	US
Telephone Number	:	706-845-4045
Fax Number	:	706-845-4367

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2006
Last Update Date	:	07/10/2018

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Directions to “ MINERVA VILLAFANE MD” Practice Location

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