Provider Demographics
NPI:1578025474
Name:VILLA, ERICA
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:VILLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7572
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5131 W BROAD ST
Practice Address - Street 2:STE 310-C
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228
Practice Address - Country:US
Practice Address - Phone:614-544-1880
Practice Address - Fax:614-544-1087
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.017459208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery