Basic Information
| Provider Information | |||||||||
| NPI: | 1518901404 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VILLAS | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2501 OREGON PIKE | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176014890 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172933223 | ||||||||
| FaxNumber: | 7173902455 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 OLD YORK ROAD | ||||||||
| Address2: | RADIOLOGY GROUP OF ABINGTON PC | ||||||||
| City: | ABINGTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190013788 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154812000 | ||||||||
| FaxNumber: | 2154812208 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2006 | ||||||||
| LastUpdateDate: | 01/08/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | MD066055L | PA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0204X | MD066055L | PA | N | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
ID Information
| ID | Type | State | Issuer | Description | 001841315 | 05 | PA | MEDICAID |