MEDICARE: DR. EDWIN VILLAMATER M.D.

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	207L00000X	Anesthesiology Physician	D42622	MD
2	207L00000X	Anesthesiology Physician	MD423862	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	50050046	OTHER	MD	RR MEDICARE #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CA8702	OTHER	MD	RR GROUP #

General Provider Information

NPI Number	:	1093784803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWIN VILLAMATER M.D.

Provider Business Mailing Address
First Line	:	PO BOX 132
Second Line	:
City	:	STEVENSON
State	:	MD
Zip	:	21153-0132
Country	:	US
Telephone Number	:	410-321-4535
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 KERNAN DR
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21207-6665
Country	:	US
Telephone Number	:	410-328-6720
Fax Number	:

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

Provider Enumeration Date	:	03/15/2006
Last Update Date	:	12/27/2023

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Directions to “ DR. EDWIN VILLAMATER M.D.” Practice Location

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