Basic Information
| Provider Information | |||||||||
| NPI: | 1881611671 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VILLARET | ||||||||
| FirstName: | DOUGLAS | ||||||||
| MiddleName: | BRIAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6035 FAIRVIEW RD | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282103256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042953000 | ||||||||
| FaxNumber: | 7042953666 | ||||||||
| Practice Location | |||||||||
| Address1: | 6035 FAIRVIEW RD | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282103256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042953000 | ||||||||
| FaxNumber: | 7042953666 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2006 | ||||||||
| LastUpdateDate: | 04/26/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | ME82588 | FL | N | Allopathic & Osteopathic Physicians | Otolaryngology | 207Y00000X | 31310 | SC | N | Allopathic & Osteopathic Physicians | Otolaryngology | 207Y00000X | 2008-00816 | NC | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 3376774 | 01 | NC | CIGNA | OTHER | 5909907 | 05 | NC | MEDICAID | 20083727 | 01 | SC | SELECT HEALTH OF SC | OTHER | 257097100 | 05 | FL | MEDICAID | N16008 | 05 | SC | MEDICAID | 01205369 | 01 | SC | AMERIGROUP COMMUNITY CARE | OTHER | 89696 | 01 | SC | CHCARES OF SC | OTHER | 56162 | 01 | NC | MEDCOST | OTHER |