Mario Francisco Victoria, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

208358 Issued in NY

Practice address

18969 US Route 11
5699 Outer Washington Street
Watertown, NY 13601-5320

Phone

(315) 782-4391

Fax

(315) 788-8319

NPI assigned

May 12, 2006

Last updated

Mar 13, 2013By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Pediatric Associates of Watertown P.C.

  • Pediatrics Physician
  • Watertown, NY
  • NPI 1497855670
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1363132800000",
    "number": "1811947393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6600",
            "address_2": "18969 US ROUTE 11",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136016600",
            "telephone_number": "315-782-4391",
            "fax_number": "315-788-8319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18969 US ROUTE 11",
            "address_2": "5699 OUTER WASHINGTON STREET",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136015320",
            "telephone_number": "315-782-4391",
            "fax_number": "315-788-8319"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VICTORIA",
        "first_name": "MARIO",
        "middle_name": "FRANCISCO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-12",
        "last_updated": "2013-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "208358",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01900196",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tiffany Joi Vaughn, NP-C
• Catherine E Veley, FNP
• Elizabeth A Verno, FNP-C
• Allison Vespa, P.T.
• Vibrant Life Health Coach LLC
• Eric Timothy Victorino, LMHC, LPC
• Erlinda P Vidal, M.D.
• Mia Vierthaler
• Selina M Villanueva, N.P.
• Heather Marie Villarreal, LMSW, CASAC

• Pediatrics Physician in Watertown, NY
• Providers in Watertown, NY by specialty
• Pediatrics Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.