Provider Demographics
NPI:1912351032
Name:VILLANUEVA, ANDREW RAUL (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:RAUL
Last Name:VILLANUEVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:1157 FIRST COLONIAL RD STE 300
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-2432
Practice Address - Country:US
Practice Address - Phone:757-333-8001
Practice Address - Fax:757-333-8002
Is Sole Proprietor?:No
Enumeration Date:2016-04-14
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2022-01217207N00000X, 207ND0101X
VA0101268875207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery