Individual
DR. ENRIQUE VILLA MARANA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3485 N MAIN ST, FARMVILLE, NC 27828-1466
(252) 753-3193
(252) 753-7966
Mailing address
3485 N MAIN ST, FARMVILLE, NC 27828-1466
(252) 753-3193
(252) 753-7966
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
20000090
NC
207RA0000X
Adolescent Medicine (Internal Medicine) Physician
200000090
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
126A3
BLUE CROSS BLUE SHIELD
NC
05
—
89126A3
—
NC
01
—
P00379704
RAILROAD MEDICARE
NC
Enumeration date
04/05/2006
Last updated
02/17/2010
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