Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | MD064792L | PA |
NPI | 1447201827 |
---|---|
Provider Name | Dr. John B Villeneuve |
First Address | Reading, PA 19612-3579 |
Second Address | West Reading, PA 19611-1428 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 04/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0017180350004 | (05) | PA |
7799403 | (05) | NJ |
G21688 | (02) |