1790740199 NPI number — PRISCILLA A VILLAROMAN M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790740199 NPI number — PRISCILLA A VILLAROMAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VILLAROMAN
Provider First Name:
PRISCILLA
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790740199
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 776351
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60677-6351
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-588-9490
Provider Business Mailing Address Fax Number:
502-272-5116

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
825 BARRET AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40204-1743
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-540-7200
Provider Business Practice Location Address Fax Number:
502-540-7207
Provider Enumeration Date:
04/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  01046413A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 37986 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000023033C . This is a "HUMANA- NORTON" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 2447469000 . This is a "PASSPORT ADVAN-N ALBANY" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 3315960000 . This is a "PASSOPRT ADVANTAGE / NMCA BARRET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 50006201 . This is a "PASSPORT / NCMA NEW ALBANY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1204806 . This is a "CHA- NORTON" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 7100009560 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50016180 . This is a "PASSPORT- BARRET AVENORT" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: P00410683 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1361920 . This is a "MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 200153800 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 007048 . This is a "SIHO- NORTON" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 1902282 . This is a "CIGNA- NORTON" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 2447469000 . This is a "PASSPORT ADVANTAGE / NCMA NEW ALBANY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200153800 . This is a "MD WISE- NORTON" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000300133 . This is a "ANTHEM- NORTON" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: P00021727 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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