Provider Demographics
NPI:1447493416
Name:VILLARI, CRAIG R (MD)
Entity type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:R
Last Name:VILLARI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 8TH AVE NE STE 310
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98029-5436
Mailing Address - Country:US
Mailing Address - Phone:425-454-3938
Mailing Address - Fax:425-392-3561
Practice Address - Street 1:510 8TH AVE NE STE 310
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98029
Practice Address - Country:US
Practice Address - Phone:425-454-3938
Practice Address - Fax:425-392-3561
Is Sole Proprietor?:No
Enumeration Date:2009-04-07
Last Update Date:2019-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA128811207Y00000X
GA73869207Y00000X
WAMD60921000207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2121854Medicaid