Provider Demographics
NPI:1548581481
Name:VILENSKY, DMITRY A (MD)
Entity type:Individual
Prefix:
First Name:DMITRY
Middle Name:A
Last Name:VILENSKY
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 1:1315 S ALLEN ST STE 104
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-5923
Mailing Address - Country:US
Mailing Address - Phone:814-753-4422
Mailing Address - Fax:
Practice Address - Street 1:1315 S ALLEN ST
Practice Address - Street 2:SUITE 104, 2ND FLOOR
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-5923
Practice Address - Country:US
Practice Address - Phone:814-753-4422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-15
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4510332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry