Provider Demographics
NPI:1528139771
Name:VILLAGRA, JOSE D (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:D
Last Name:VILLAGRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2730 UNIVERSITY BLVD W STE 410
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:MD
Mailing Address - Zip Code:20902-1972
Mailing Address - Country:US
Mailing Address - Phone:240-669-6330
Mailing Address - Fax:240-669-6757
Practice Address - Street 1:2730 UNIVERSITY BLVD W STE 410
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:MD
Practice Address - Zip Code:20902-1972
Practice Address - Country:US
Practice Address - Phone:240-669-6330
Practice Address - Fax:240-669-6757
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0059258208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
I47354Medicare UPIN