Provider Demographics
NPI:1053499079
Name:WINGER, ROGER (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:
Last Name:WINGER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-4019
Mailing Address - Country:US
Mailing Address - Phone:740-387-5572
Mailing Address - Fax:
Practice Address - Street 1:1199 DELAWARE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6475
Practice Address - Country:US
Practice Address - Phone:740-383-2513
Practice Address - Fax:740-387-6495
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA-00072237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH46-00009OtherUNITEDHEALTHCARE
OH000000116916OtherANTHEM
OH0135133Medicaid
OH46-00009OtherUNITEDHEALTHCARE