MEDICARE: DR. TIBISAY I VILLALOBOS 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	2080P0208X	Pediatric Infectious Diseases Physician	MD447355	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	:	1225037591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIBISAY I VILLALOBOS MD

Provider Business Mailing Address
First Line	:	1210 S CEDAR CREST BLVD
Second Line	:	SUITE 2400
City	:	ALLENTOWN
State	:	PA
Zip	:	18103-6229
Country	:	US
Telephone Number	:	610-402-3824
Fax Number	:	610-402-3893

Provider Business Practice Location Address
First Line	:	1210 S CEDAR CREST BLVD
Second Line	:	SUITE 2400
City	:	ALLENTOWN
State	:	PA
Zip	:	18103-6229
Country	:	US
Telephone Number	:	610-402-3824
Fax Number	:	610-402-3893

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

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	06/17/2015

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