Provider Demographics
NPI:1306803168
Name:VILLAGOMEZ, MARGO (NP)
Entity type:Individual
Prefix:MS
First Name:MARGO
Middle Name:
Last Name:VILLAGOMEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:93 N RYAN ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14210-2308
Mailing Address - Country:US
Mailing Address - Phone:716-855-1099
Mailing Address - Fax:716-855-1310
Practice Address - Street 1:300 S ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14201-2361
Practice Address - Country:US
Practice Address - Phone:716-855-1099
Practice Address - Fax:716-855-1310
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF-380696363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics