Provider Demographics
NPI:1548254477
Name:WILLARD, VIRGIL VICTOR II (MD)
Entity type:Individual
Prefix:DR
First Name:VIRGIL
Middle Name:VICTOR
Last Name:WILLARD
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1011 N LINDSAY ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-3944
Mailing Address - Country:US
Mailing Address - Phone:336-886-1667
Mailing Address - Fax:336-886-5536
Practice Address - Street 1:1011 N LINDSAY ST
Practice Address - Street 2:SUITE 202
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-3944
Practice Address - Country:US
Practice Address - Phone:336-886-1667
Practice Address - Fax:336-886-5536
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26413174400000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8987635Medicaid
NCC82374Medicare UPIN
NC8987635Medicaid
NC204198AMedicare ID - Type Unspecified