Provider Demographics
NPI:1598780397
Name:VILLACORTE, LIZETTE (MD)
Entity type:Individual
Prefix:DR
First Name:LIZETTE
Middle Name:
Last Name:VILLACORTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 1ST AVE NW
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-6122
Mailing Address - Country:US
Mailing Address - Phone:828-695-5900
Mailing Address - Fax:828-695-4256
Practice Address - Street 1:327 1ST AVE NW
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-6122
Practice Address - Country:US
Practice Address - Phone:828-695-5900
Practice Address - Fax:828-695-4256
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2003011862084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1598780397Medicaid
NC135K4OtherNC BCBS
NC135K4OtherNC BCBS
NC2024495Medicare ID - Type UnspecifiedMEDICARE NC
NCBV8490714OtherDEA - NC
NC2024495Medicare PIN